Sacroplasty

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Question:

The doctor did a vertebroplasty of the S1 segment of the sacrum. I used code 0200T for this procedure and Medicare denied stating “procedure/treatment has not been deemed proven effective by payer”. Is there another code I should have used or is there a way to get some type of reimbursement for this procedure from Medicare?

Answer:

Yes, 0200T is the correct code for a percutaneous sacroplasty. Unfortunately, Medicare does not have a standard payment policy for this code but leaves it up to each local carrier to determine whether they will pay. Wish I had better news for you.