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HumanaMedicare Advantage · Coverage · Medicare Advantage · Orthopedics, Neurosurgery, Radiology +1 moreMedium impact

Percutaneous Vertebroplasty, Kyphoplasty, Sacroplasty - Medicare Advantage (Revised)

Effective date
Feb 2, 2026
Identified
Jun 24, 2026

Summary

Humana Medicare Advantage has updated its policy for percutaneous vertebroplasty, kyphoplasty, and sacroplasty procedures, clarifying coverage criteria based on geographic jurisdictions and explicitly stating that sacroplasty will not be considered medically reasonable and necessary. The policy consolidates coverage determinations across different Medicare Administrative Contractor regions.

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What to do

Action · 3 steps
01Before February 2, 2026: Billing team must update system to deny sacroplasty procedures (codes 0200T, 0201T) for all Humana Medicare Advantage plans as they will not be covered.
02For vertebroplasty/kyphoplasty procedures (22510-22515, C7507, C7508), verify coverage criteria based on your MAC jurisdiction using the specific LCD referenced in the policy.
03Update encounter forms to alert providers that sacroplasty is not covered.

Codes mentioned

225102251122512225132251422515C7507C7508

Original notice

Percutaneous Vertebroplasty, Kyphoplasty, Sacroplasty - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
View original ↗

Related policy hubs

Humana policiesOrthopedicsNeurosurgeryRadiologyPain ManagementCode 22510Code 22511Code 22512Code 22513Code 22514Code 22515Code C7507Code C7508

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