Billing and Coding: Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF) - R3

This coverage article has been revised and published for notice under contract numbers: 02101 (AK), 02201 (ID), 02301(OR), 02401 (WA), 03101 (AZ), 03201 (MT), 03301 (ND), 03401 (SD), 03501 (UT), and 03601 (WY).

Effective Date: February 19, 2020
Summary of Article Changes:
Addition of ICD-10 Group 2 Paragraph:
Medicare is establishing the following limited coverage of 22510, 22511, 22512, 22513, 22514 and 22515 for Malignant Fractures.

Addition of ICD-10 Group 2: Codes:
C41.2*: Malignant neoplasm of vertebral column
C79.51*: Secondary malignant neoplasm of bone
C90.00*: Multiple myeloma not having achieved remission
C90.02*: Multiple myeloma in relapse
M84.58XA: Pathological fracture in neoplastic disease, other specified site, initial encounter for fracture
M84.58XS: Pathological fracture in neoplastic disease, another specified site, sequela

Addition of Group 2: Medical Necessity ICD-10 Codes Asterisk:
*Must be reported with either M84.58XA or M84.58XS.

Visit the Noridian Medicare Coverage Articles webpage to view the complete listing of locally hosted coverage articles and/or access the Active, Future, or Retired articles available in the CMS MCD.


            Last Updated Wed, 27 May 2020 14:24:59 +0000