CPT 0200T · Vertebral Augmentation · Independence Blue Cross
Sacroplasty — Unilateral at Independence Blue Cross.
How Independence Blue Cross approaches CPT 0200T (Sacroplasty — Unilateral) for prior-authorization review: at last review on 2026-04-26, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-04-26
Policy number
Clearway-MPG-SacroplastyCriteria summary
High-level themes from the Independence Blue Cross policy of record for CPT 0200T. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 4 weeks of conservative care typically required.
- Imaging concordance documentation required.
Source: Clearway Master Payer Guidelines v2025 — Sacroplasty
See the full Independence Blue Cross criteria.
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