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Blue Cross & Blue Shield of MississippiAll Plans · Coverage · Medical Policy · Orthopedics, Pain Management, OncologyMedium impact

Minimally Invasive Approaches to Vertebral Fractures and Osteolytic Lesions of the Spine

Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

Percutaneous vertebroplasty may be considered medically necessary for symptomatic osteoporotic vertebral fractures that have failed to respond to conservative treatment (such as analgesics, physical therapy and rest) for at least 6 weeks, for symptomatic osteoporotic fractures less than 6 weeks old that have led to hospitalization or persist at a level that prevents ambulation, and for severe pain due to osteolytic lesions of the spine related to multiple myeloma or metastatic malignancies. Balloon kyphoplasty and mechanical vertebral augmentation with an FDA-cleared device follow similar criteria, while radiofrequency kyphoplasty and percutaneous sacroplasty are considered investigational. Investigational treatments are not considered medically necessary.

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What to do

Action · 4 steps
01Billing team: Before billing vertebroplasty, kyphoplasty or mechanical vertebral augmentation, confirm the documentation shows the criteria in the policy, because BCBSMS makes no payment for services not documented to be medically necessary, and a physician's prescription or recommendation does not in itself make a service medically necessary.
02For osteoporotic fractures, the documentation should show failure of conservative treatment for at least 6 weeks, or the other osteoporotic fracture criteria stated in the policy.
03Claims for percutaneous sacroplasty (CPT 0200T and 0201T), radiofrequency kyphoplasty, and vertebroplasty or kyphoplasty for acute vertebral fractures due to osteoporosis or trauma are considered investigational.
04The coverage guidelines in the Medical Policy Manual should not be used in lieu of the member's specific benefit plan language.

Codes mentioned

225102251122512225132251422515C41.2C79.51C79.52C81.7AC90.00C90.02D48.0D49.2M48.50XAM48.58XSM80.08XAM80.08XSM80.88XAM80.88XSM84.48XAM84.48XSM84.58XAM84.58XSM84.68XAM84.68XS

Original notice

Minimally Invasive Approaches to Vertebral Fractures and Osteolytic Lesions of the Spine
bcbsms.com · Always check the source before changing claims.
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