In April, Medicare Administrator Contractor (MAC) carrier Noridian published Carrier Advisory Committee (CAC) Voting Results for a draft policy on Vertebral Augmentation. The CAC meeting took place in March based on a draft policy that had been previously published.
Several providers and specialty societies provided input to Noridian and the CAC members on clinical standards and current literature for Vertebral Augmentation, including ISASS through a letter sent to Noridian. The letter was reviewed by the CAC for the March meeting.
The CAC process is used by Medicare Administrator Contractors such as Noridian to review clinical literature on new and emerging technologies under consideration for payment policies for various Medicare jurisdictions.
CAC members are drawn from the physician community for each jurisdiction and are convened to review technologies through a public process.
The final Vertebral Augmentation policy for Noridian will be published in coming weeks.
The letter can be viewed here: Letter to CAC – Supporter Signatories (1)
A link to CAC voting results can be viewed here.
In response to the CAC vote and the public input, Noridian posted an updated draft policy, which provides a positive coverage recommendation for vertebral augmentation, stating that percutaneous vertebroplasty or kyphoplasty could be covered for patients with acute vertebral compression fracture between the fifth lumbar and fifth thoracic vertebrae as diagnosed by MR or bone-scan SPECT/CT within prior 30 days. The patient would have to have been admitted for severe pain as defined by either of two pain scales, or alternately to have been treated for moderate to severe pain despite optimal non-surgical management. The updated draft policy is posted on the Noridian and open for comment through July 19, 2019
A link to the updated draft can be viewed here.