Medicare Benefits Schedule - Item 35401

Vertebroplasty, for one or more fractures in one or more vertebrae, for the treatment of a painful osteoporotic thoracolumbar vertebral compression fracture of the thoracolumbar spinal segment (T11, T12, L1 or L2), if:

(a) the service is performed by a specialist or consultant physician practicing in the specialist's or consultant physician's speciality of diagnostic radiology, neurosurgery, neurology or orthopaedic surgery; and

(b) the specialist or consultant physician has undertaken appropriate training in the vertebroplasty procedure; and

(c) pain is severe (numeric rated pain score greater than or equal to 7 out of 10); and

(d) the symptoms are poorly controlled by opiate therapy; and

(e) the severe pain duration is 3 weeks or less; and

(f) there is MRI (or SPECT‑CT if MRI unavailable) evidence of acute vertebral fracture

Applicable only once for the same fracture, but is applicable for a new fracture of the same vertebra or vertebrae (H)

Multiple Operation Rule

(Anaes.)

Fee: $796.55 Benefit: 75% = $597.45

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