CPT 0201T · Vertebral Augmentation · UnitedHealthcare Medicare Advantage
Sacroplasty — Bilateral at UnitedHealthcare Medicare Advantage.
How UnitedHealthcare Medicare Advantage approaches CPT 0201T (Sacroplasty — Bilateral) for prior-authorization review: at last review on 2026-04-26, the policy does not cover this code with prior authorization required.
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Clearway-MPG-SacroplastyCriteria summary
High-level themes from the UnitedHealthcare Medicare Advantage policy of record for CPT 0201T. 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 UnitedHealthcare Medicare Advantage criteria.
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