The Vertiflex™ Procedure† is the only FDA approved, minimally invasive treatment, clinically proven to treat pain symptoms associated with moderate lumbar spinal stenosis (LSS). Most patients indicated for the Vertiflex Procedure have insurance coverage through original Medicare and a growing number of private health plans.3,4
Talk with someone from our Health Economics and Market Access team. Discover ways you can identify appropriate candidates for the Vertiflex Procedure and support patient access to care.
Your voice: Advocate for access to care
Patients afflicted with LSS face limited treatment options apart from surgical or conservative care. The Multispecialty Pain Workgroup (MPW) and state societies published position statements in support of indirect decompression procedures based upon Level 1–5 data for a well-defined patient population.1,2 In addition, the 2019 HHS Pain Management Best Practices Inter-Agency Task Force Report encourages use of non-fusion interspinous spacers for well selected patients.
The Vertiflex Procedure is the only FDA approved minimally invasive treatment clinically proven to treat pain symptoms associated with moderate LSS. The Vertiflex Procedure is supported by a 5-year Level 1 RCT and more than 30 peer-reviewed journal publications demonstrating durable efficacy and safety.
Most patients indicated for the Vertiflex Procedure have insurance coverage through original Medicare and a growing number of private health plans.3,4
The Boston Scientific Healthcare Economics and Market Access professionals can assist you and your office staff with navigating the insurance process and educating payers about spinal stenosis, alternative treatments, patient selection and outcomes. Contact our experts.
Your engagement with local health plans is essential to ensure payers understand patient selection criteria and conditions for insurance coverage.
Take action
- Speak with your patients about whether the Vertiflex Procedure could be an effective solution for their personal pain
- Connect with Boston Scientific Healthcare Economics and Market Access professionals for personalized support
- Actively engage and educate policymakers about LSS, appropriate patient selection and published outcomes unique to the Vertiflex Procedure
Your resources: Reimbursement support
Tools such as quick reference guides, clinical documentation resources, and appeal template letters are available to assist you in streamlining the preauthorization and appeal requests with payers.
Your impact: Read Susan’s story
“On a scale of one to 10, I used to rate my daily pain at a level of eight or nine. Now, I wake up every day refreshed and ready for a new adventure.”*
† The Superion Indirect Decompression System (IDS)
* The patient quotes in this material describe real personal experiences. Individual results may vary. Patients can experience different levels of pain management and different changes in their activities and use of medications. Consult with your physician to determine if you are a candidate for this procedure and what you may gain from the therapy.
References:
1. MPW consensus position statement and letter to national payers and health technology assessment groups released April 8, 2022. Signatories included: American Academy of Physical Medicine and Rehabilitation American Society of Anesthesiologists American Society of Neuroradiology American Society of Spine Radiology North American Neuromodulation Society North American Spine Society, the Society of Interventional Radiology as well as the Spine Intervention Society. Interspinous Spacer Device Coverage — Spine Intervention Society.
2. As of May 11, 2022, 16 State societies representing pain management specialist include:
Arkansas-SIPP, Connecticut Pain Society (letter), Florida-SIPP (letter), Hawaii-SIPP, Iowa-SIPP, Idaho-SIPP, Kansas-SIPP, Michigan-SIPP, Missouri-SIPP, New York-SIPP, Ohio-SIPP, Pennsylvania-SIPP, South Carolina-SIPP, Illinois-SIPP, Maine-SIPP and the Texas Pain Society.
3. Benefits are made available through Original Medicare, with coverage provided by statute under the Social Security Act
§1862(a)(1)(A). Beneficiaries must always meet medical necessity criteria, as reflected within physician clinical notes.
4. As of April 12, 2022: BCBS Michigan, Highmark BCBS, Inland Empire Health Plan, Dean Health plan and its subsidiaries\, Wellcare Health Plans, Ventura County Health Plan, Emblem Health, Prevea360, Paramount Healthcare and Blue Shield of California (retired non-coverage policy; maintains silent coverage based upon medical necessity). Use of Boston Scientific’s Reimbursement Center for benefit verification, prior authorization and appeals is encouraged for all cases.
5. Approximately 70% of all ALJ cases to date have been adjudicated in favor of the Medicare beneficiary. Concurrent grievances are filed against health plans denying coverage, as routinely provide through Original Medicare. Use of Boston Scientific template clinic notes and checklists are strongly encouraged, as made available through ShowPad and Regional Reimbursement Management staff.
Indications for Use: The Superion™ Indirect Decompression System (IDS) is indicated to treat skeletally mature patients suffering from pain, numbness, and/or cramping in the legs (neurogenic intermittent claudication) secondary to a diagnosis of moderate degenerative lumbar spinal stenosis, with or without Grade 1 spondylolisthesis, having radiographic evidence of thickened ligamentum flavum, narrowed lateral recess, and/or central canal or foraminal narrowing. The Superion™ Interspinous Spacer is indicated for those patients with impaired physical function who experience relief in flexion from symptoms of leg/buttock/groin pain, with or without back pain, who have undergone at least 6 months of non-operative treatment. The Superion Interspinous Spacer may be implanted at one or two adjacent lumbar levels in patients in whom treatment is indicated at no more than two levels, from L1 to L5. Contraindications, warnings, precautions, side effects. The Superion Indirect Decompression System (IDS) is contraindicated for patients who: have spinal anatomy that prevent implantation of the device or cause the device to be unstable in situ (i.e., degenerative spondylolisthesis greater than grade 1), Cauda equina syndrome, or prior decompression or fusion at the index level. Refer to the Instructions for Use provided on www.vertiflex.com for additional Indications for Use, contraindications information and potential adverse effects, warnings, and precautions prior to using this product. Caution: U.S. Federal law restricts this device to sale by or on the order of a physician.