Local Coverage Article Response to Comments

Response to Comments: Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)


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Article ID
Article Title
Response to Comments: Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)
Article Type
Response to Comments
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Retirement Date
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Article Text

The comment period for the Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) DL38737 Local Coverage Determination (LCD) began on 3/31/22 and ended on 5/14/22. The notice period for L38737 begins on 7/7/22 and will become effective on 8/21/22.

The title of the LCD was revised from Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF) to Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)

The comment below was received from the provider community.

Response To Comments


Palmetto GBA recently retired Local Coverage Article (LCA) A56819. This LCA has been replaced by Palmetto GBA LCA A58275 and Palmetto GBA Local Coverage Determination (LCD) L38737.

Local Coverage Article A58275 is highly restrictive and inadequate in its publication of ICD-10 Codes that Support Medical Necessity. Only four ICD-10 codes are listed, all of which relate to osteoporotic fractures only, M80.08XA, M80.08XS, M80.88XA and M80.88XA. These fail to encompass other common etiologies of vertebral compression fractures, including malignancy, endocrine disease, drug inducement, and injury or consequences of external causes.

Additionally, please consider the designation of “fragility fractures” as the diagnosis of osteoporosis can only be made in retrospect after the patient has undergone a DEXA scan.

In particular, by omitting coverage for malignant fractures, the patients with cancer in our region may endure unnecessary pain and suffering related to malignancy-related VCFs. PVA has been well established to be safe and effective in the treatment of malignancy-related VCFs through randomized, controlled trials, such as the CAFE Trial (Berenson, et al. Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial. 2011. The Lancet Oncology).

We are requesting Palmetto GBA to retroactively modify, update or replace LCD L38737 and LCA A58275 in order to sufficiently allow coverage for all VCF medically necessary conditions requiring PVA, specifically in the case of malignant compression fractures.

Thank you for your time and consideration.

There were multiple similarly worded comment letters which are summarized above. Please review the most recent LCD and associated article which adds evidence and codes for malignancy related fractures. In regard to other indications there was no evidence supplied with your request therefore we cannot modify the LCD and associated article. Please consider requesting an LCD reconsideration by supplying the required information per the LCD reconsideration process article available on Palmetto GBA’s website.

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