CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Anterior fusionless scoliosis technologies (vertebral body stapling and tethering) coverage criteria

This policy governs coverage and medical necessity determinations for vertebral body stapling and vertebral body tethering (fusionless surgical procedures) for juvenile and adolescent idiopathic scoliosis for Blue Cross Blue Shield - Rhode Island members.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyAnterior fusionless scoliosis technologies (vertebral body stapling and tethering) coverage criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionVerify member benefits and prior authorization requirements with the plan before providing services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

InsufficientPayer conclusion

Medicare & CommercialApplies to

39Refs

4Codes listed

Coverage and Medical Necessity Determinations

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coverage stance

Payer coverage conclusions

Medicare Advantage Plans: Vertebral body stapling and vertebral body tethering for the treatment of scoliosis are not covered for Medicare Advantage Plans as the evidence is insufficient to determine that the technology results in an improvement in the net health outcomes.

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Commercial Products: Vertebral body stapling and vertebral body tethering for the treatment of scoliosis are not medically necessary for Commercial Products as the evidence is insufficient to determine that the technology results in an improvement in the net health outcomes.

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This policy review specifically excludes patients who are not at high‑risk of progression and those who are candidates for conventional fusion surgery. Examples include patients with Cobb angles measuring 45° or more, for whom this review does not address the use of vertebral body stapling or tethering.

Coverage and exclusions under this policy are determined by the member’s subscriber agreement, member certificate, and/or employer agreement, which supersede the medical policy. This document is informational and not a guarantee of payment; providers should verify member‑specific benefits by contacting the provider call center as needed.

For Commercial Products, vertebral body stapling and vertebral body tethering are considered not medically necessary because the evidence is insufficient to demonstrate an improvement in net health outcomes. In addition, the following vertebral body tethering procedure codes are identified as not covered/not medically necessary: 22836, 22837, 22838, 0790T (new codes effective 01/01/2024).

Procedure and Billing Codes

Not covered / Not medically necessary procedure codesCPTNot Covered

22836	Anterior thoracic vertebral body tethering, including thoracoscopy, when performed; up to 7 vertebral segments (New code effective 1/01/2024)
22837	Anterior thoracic vertebral body tethering, including thoracoscopy, when performed; 8 or more vertebral segments (New code effective 1/01/2024)
22838	Revision (eg, augmentation, division of tether), replacement, or removal of thoracic vertebral body tethering, including thoracoscopy, when performed (New code effective 1/01/2024)
0790T	Revision (eg, augmentation, division of tether), replacement, or removal of thoracolumbar or lumbar vertebral body tethering, including thoracoscopy, when performed (New code effective 1/01/2024)

Provider Requirements, Prior Authorization, and Billing Alerts

Prior Authorization

Prior authorization is not required for these services.

Note

Verify coverage and prior authorization

Verify member benefits and any payer-required reviews prior to scheduling. Benefits may vary by contract; refer to the member's Evidence of Coverage or Subscriber Agreement. For member-specific benefit information, contact the provider call center.

Benefits may vary between groups/contracts; refer to the Evidence of Coverage or Subscriber Agreement.
For member-specific benefits call the provider call center.

Step Therapy

Step therapy / criteria

Step therapy / specific medical criteria: Not applicable.

Billing Rule

Member benefits verification

Determine member-specific benefits via the subscriber agreement or member certificate. If services are determined not medically necessary or are non-covered benefits, providers may not bill the member unless the member was informed and provided written agreement to pay in advance. Refer to participation agreements for applicable billing/collection provisions.

If services are not medically necessary, provider liability for payment may apply unless member provided written agreement.
Refer to participation agreement(s) and member subscriber agreement for benefit details.

Denial Risk

Coverage and billing/denial risk

Procedures are not covered for Medicare Advantage Plans and are not medically necessary for Commercial Products. Services determined not medically necessary may result in denial and potential provider liability for payment or member balance billing restrictions.

Medicare Advantage Plans: not covered.
Commercial Products: not medically necessary.

Clinical Background and Context

Adolescent idiopathic scoliosis is an abnormal lateral and rotational curvature of the spine that typically begins at age ≥10 and carries a risk of progression during growth. Curve magnitude is measured by the Cobb angle, and skeletal maturity (for example, assessed by the Risser sign) informs remaining growth and the likelihood of curve progression. Vertebral body stapling and vertebral body tethering are fusionless, growth‑modulating surgical approaches proposed as alternatives to bracing for juvenile and adolescent patients at high risk of progression; however, this review focuses on those high‑risk patients and does not address patients who are not at high risk or who are candidates for conventional fusion.

Key Definitions and Clinical Measures

inv-15: Cobb angle — definition and use to measure curve magnitude.

DefinitionCobb angle is the angle formed between intersecting lines drawn perpendicular to the top and bottom vertebrae of the curve and is used to measure curve magnitude.

Measurement methodLines are drawn perpendicular to the superior endplate of the top vertebra and the inferior endplate of the bottom vertebra of the curve; the intersecting angle is the Cobb angle.

Clinical usePrimary radiographic measure of scoliosis severity and used to track curve progression during growth.

ContextApplied in diagnosis and monitoring of adolescent idiopathic scoliosis (onset ≥10 years) where progression risk is highest during puberty.

inv-16: Risser sign — definition and relevance to remaining spinal growth.

DefinitionRisser sign measures ossification of the iliac apophysis to estimate remaining spinal growth, graded 0 to 5.

Grade meaningRisser 0–1: immature (0%–25% ossification) indicating substantial remaining growth; Risser 5: full ossification indicating skeletal maturity with no remaining spinal growth.

Clinical relevanceRisser grade informs risk of scoliosis curve progression during growth and aids treatment timing decisions.

Progression notePatients may progress from low to high Risser grades over a brief period (eg, ~2 years), so serial assessment is important.

inv-17: Anterior vertebral body tethering (AVBT) / Vertebral body tethering (VBT) — definition of the fusionless growth-modulating technique.

DefinitionAnterior vertebral body tethering (AVBT) / Vertebral body tethering (VBT) is a fusionless, growth‑modulating surgical technique that applies a tether to the convex side of the spinal curve to modulate growth and correct deformity in growing patients with idiopathic scoliosis.

PurposeProposed as an alternative to spinal fusion or bracing for immature patients at high risk of progression to preserve spinal motion while guiding growth.

Evidence contextTechnique is described in multiple clinical series and position statements (eg, SRS/POSNA joint position statement, 2020) and referenced clinical studies of AVBT outcomes.

Regulatory/Policy noteDespite reported clinical series, payer conclusions cite insufficient evidence to determine improvement in net health outcomes for stapling and tethering.