Vertebral Body Tethering Scoliosis
This UnitedHealthcare medical policy defines clinical and facility criteria under which vertebral body tethering (VBT) surgery and VBT revision surgery may be considered medically necessary for adolescent idiopathic scoliosis, and states that VBT is not medically necessary when criteria are not met. It applies to UnitedHealthcare Commercial and Individual Exchange benefit plans.
Revised coverage rationale to specify detailed clinical criteria, facility requirements, surgeon/research participation, and shared decision-making for VBT to be medically necessary.
Added/clarified facility and surgeon requirements including onsite pediatric scoliosis program, inpatient pediatric physical therapy, intraoperative advanced imaging, pediatric anesthesiologist, and pediatric ICU.
Specified revision surgery may be medically necessary for tether breakage, hardware failure, under/over-correction, or removal of hardware for complications (e.g., impingement, infection, intractable pain).
Added language indicating benefit coverage is determined by the member-specific benefit plan and that medical records documentation may be required to assess clinical criteria for coverage.
Referenced FDA labeling and Humanitarian Device Exemption for The Tether™ system and alignment with research study/IRB participation for coverage.
Added language indicating benefit coverage is determined by the member-specific benefit plan and applicable laws, and that medical records documentation may be required to assess clinical criteria for coverage.
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