CommercialCoverageHigh impact
Percutaneous Vertebroplasty/Mechanical Vertebral Augmentation and Percutaneous Sacroplasty 6.01.17
Excellus BlueCross BlueShield·Orthopedics, Neurosurgery, Pain Management +1 more·Bone & Joints (Orthopedic)
Effective date
Oct 15, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated medical policy 6.01.17 for percutaneous vertebroplasty, kyphoplasty, and sacroplasty procedures effective October 15, 2025. The policy establishes detailed criteria for medical necessity including specific indications for malignant conditions, non-malignant conditions, and associated surgical procedures, while listing multiple contraindications and investigational uses.
Action Required
Before October 15, 2025: Billing and clinical teams must update prior authorization processes for vertebroplasty and kyphoplasty procedures to ensure all medical necessity criteria are documented. Providers must document imaging concordance with symptoms, functional impairment levels, conservative treatment trials (4+ weeks for subacute cases), and enrollment in osteoporosis programs for compression fractures. Update encounter forms and EMR templates to capture required documentation elements. Claims without proper documentation meeting the specific policy criteria will be denied.