Radiology societies urge commercial payers to update coverage for key interventional procedure

Radiology societies are urging commercial insurers to update coverage for a key interventional procedure. 

A total of 10 professional associations—also representing pain medicine, anesthesia and rehab specialists—recently messaged more than a dozen payers across the U.S. They’re concerned about coverage for balloon kyphoplasty, used to treat vertebral compression fractures. 

The minimally invasive procedure utilizes a balloon-like device to prevent bones from collapsing, providing relief from painful breaks in the spine. A recently published meta-analysis found that early treatment with balloon kyphoplasty provides “statistically significant” improvement in pain scores when compared to later interventions delivered four weeks after an injury. 

Given this evidence, the Society of Interventional Radiology, American College of Radiology and others want payers to update policies to align with Medicare, permitting surgical intervention within one month.  

“Conclusions by study authors highlight the clinical benefits of early intervention on achieving appropriate pain control and kyphotic correction,” ACR, SIR, the American Society of Neuroradiology and the American Society of Spine Radiology wrote May 9. “Given these findings, we urge you to consider updating your commercial coverage criteria to permit earlier surgical intervention for the treatment of [vertebral compression fractures].”

Radiology associations also highlighted a sub study of the world’s largest registry on percutaneous vertebral augmentation. It found that an “inefficient” care pathway, with a 171-day delay to treatment, cost the healthcare system about $19,590, whereas an “efficient” pathway with only a two-day delay cost about $5,096. Typically, treating patients more quickly for compression fractures resulted in lower healthcare utilization costs along with better outcomes when compared to delayed treatment. 

Currently, all seven Medicare Administrative Contractor local coverage determinations place no restriction on reimbursement based on the time from fracture, the societies note. 

“Thus, your Medicare Advantage members may already be proceeding to surgical intervention in the acute fracture time period given the LCDs,” they wrote. “As such, an update to your commercial policy would ensure equitable patient access to care regardless of plan type.”

Payers targeted include Aetna, Blue Cross Blue Shield Health Care Service Corporation, and others, ACR said in a recent news update. The college urged radiologists to share this recent evidence with local payers. SIR also published a news update on the letter-writing campaign on May 28. 

The American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Society of Regional Anesthesia and Pain Medicine, International Pain and Spine Intervention Society, North American Neuromodulation Society, and the North American Spine Society also signed the message.