NANS Pushes for Commercial Policy Reform on VCF Surgical Timing

NANS joined ten physician societies to urge Aetna and HCSC to update their commercial coverage policy to allow earlier surgical intervention for the treatment of vertebral compression fractures (VCFs).

The current commercial policy requires failure of conservative management prior to the approval of surgical intervention with kyphoplasty or vertebroplasty. All seven Medicare Administrative Contractor (MAC) Local Coverage Determinations (LCDs) place no restriction of surgical intervention based on time from fracture.

This letter was drafted after a meta-analysis examined the impact of treatment timing on outcomes for patients with VCFs treated using balloon kyphoplasty. The study highlighted the clinical benefits of early intervention, as expedited treatments resulted in the lowest healthcare cost and improved patient outcomes. Updating the commercial policy would allow for equitable access to care regardless of plan type.

The letter was sent on May 9, 2025 to both payers. ​