Medicare WISeR service

Percutaneous Vertebral Augmentation for Vertebral Compression Fracture

The WISeR service includes percutaneous vertebroplasty and kyphoplasty. Local coverage requirements vary by Medicare Administrative Contractor.

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Documentation overview

Documentation categories to review

These categories summarize the approved criteria bundle. The note checker uses the selected state, clinical pathway and procedure details to apply the relevant criteria.

Osteoporotic vertebral compression fracture

Acute or subacute osteoporotic fracture confirmed by advanced imaging
Severity-appropriate pain despite optimal non-surgical management
Osteoporosis evaluation and treatment referral

Malignant vertebral fracture

Osteolytic vertebral metastasis or myeloma with severe back pain

Shared and jurisdiction-specific documentation

Assessment and absence of contraindications
Assessment of relative contraindications with rationale when present
In Ohio, qualifying advanced imaging performed within 30 days of the planned procedure

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Educational use only

This page summarizes public CMS documentation criteria. It does not provide medical, legal or coding advice, determine Medicare coverage, predict prior-authorization outcomes, or replace clinical judgment. Coverage decisions are made by CMS and its contractors. Verify the effective policy for the patient’s date and place of service before relying on this summary.