LCD ID Number: L35130 Status: A-Approved
LCD Title: Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)
Geographic Jurisdiction: Arkansas Other Jurisdictions
Original Determination Effective Date:
Original Determination Ending Date:
Revision Effective Date:
Revision End Date:
CMS National Coverage Policy:
This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for percutaneous vertebral augmentation (PVA) for vertebral compression fracture (VCF). Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. They are not repeated in this LCD. Neither Medicare payment policy rules nor this LCD replace, modify or supersede applicable state statutes regarding medical practice or other health practice professions acts, definitions and/or scopes of practice. All providers who report services for Medicare payment must fully understand and follow all existing laws, regulations and rules for Medicare payment for PVA for VCF and must properly submit only valid claims for them. Please review and understand them and apply the medical necessity provisions in the policy within the context of the manual rules. Relevant CMS manual instructions and policies may be found in the following Internet-Only Manuals (IOMs) published on the CMS Web site:
- CMS IOM Publication 100-04, Medicare Claims Processing Manual,
- Chapter 4, Part B Hospital (Including Inpatient Hospital Part B and OPPS), Section 10 Hospital Outpatient Prospective Payment System (OPPS)
- Chapter 13, Radiology Services and Other Diagnostic Procedures, Section 80 Supervision and Interpretation (S&I) Codes and Interventional Radiology
- CMS IOM Publication 100-08, Medicare Program Integrity Manual,
- Chapter 13, Local Coverage Determinations, Section 13.5.4 Reasonable and Necessary Provision in an LCD
Social Security Act (Title XVIII) Standard References:
- Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no Medicare payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury.
- Title XVIII of the Social Security Act, Section 1862(a)(7). This section excludes routine physical examinations.
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