Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF) (L34228) - R13 - Effective November 20, 2025

Date Posted: November 20, 2025

This Local Coverage Determination (LCD) has been revised under contractor numbers: 01111 (CA), 01211 (AS, GU, HI, NMI), 01311 (NV), and 01911 (CA, HI & Territories).

Effective Date: November 20, 2025

Summary of Changes:

Coverage Indications, Limitations and/or Medical Necessity: Revised:

"PVA (percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP)) is covered in patients with BOTH the following" to "PVA (percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP)) is covered in patients who qualify based on the following criteria"

"Exclusion criteria 2,5,8-10 (Can have NONE of the following):" to "Exclusion criteria 2,5,8-10:"

Visit the Noridian Active LCDs webpage to view the Active LCD or access it via the CMS MCD.

Last Updated Nov 19 , 2025