Interventional Radiology Prior Authorization and Denial Guide
Vertebroplasty and kyphoplasty prior authorization requirements, uterine fibroid embolization coverage criteria, peripheral arterial intervention step-therapy documentation, venous ablation coverage, and denial appeals for interventional radiology procedures. Grounded in Aetna Medical Policy for vertebroplasty and kyphoplasty, UHC CDG Interventional Radiology, CMS LCDs, and SIR clinical practice guidelines.
Vertebroplasty (CPT 22510) and kyphoplasty (CPT 22513): prior authorization is required and coverage is limited to acute osteoporotic compression fractures — most payers follow criteria requiring documented osteoporosis (T-score below -2.5 or prior fragility fracture), acute fracture of less than 3–6 months duration confirmed by MRI or bone scan showing edema, and failure of conservative management (rest, analgesics, bracing) where tolerated. Tumor-related fractures (metastatic disease) have different coverage criteria and require documentation of the underlying malignancy and fracture characteristics. NASS and SIR guidelines are cited in most payer policies.
Uterine fibroid embolization (UFE, CPT 37243): prior authorization required. Documentation must include confirmed uterine fibroid diagnosis (ultrasound or MRI with fibroid mapping), symptomatic fibroids (AUB, bulk symptoms, pelvic pain), and for most commercial payers, documentation that surgical options were discussed. UFE is covered by most major commercial payers as an alternative to hysterectomy for symptomatic fibroids in women who wish to preserve the uterus. Peripheral arterial intervention: balloon angioplasty and stenting for PAD require documentation of ABI, imaging (CTA, MRA, or duplex), and Rutherford classification of limb ischemia. Most payers require failure of supervised exercise therapy before elective intervention for claudication (Rutherford 1–3), while critical limb ischemia (Rutherford 4–6) can proceed to intervention.