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  • PILD Coverage Under CED Paradigm
  • Post author
    Lacy Gaskins

PILD Coverage Under CED Paradigm

The Centers for Medicare & Medicaid Services (CMS) requests Medicare Administrative Contractors (MACs) acknowledge Medicare coverage of Percutaneous Image-guided Lumbar Decompression (PILD) under the Coverage with Evidence Development (CED) paradigm. Coverage applies for beneficiaries with Lumbar Spinal Stenosis (LSS) enrolled in a CMS-approved prospective longitudinal study.

Full Transmittal: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R199NCD.pdf

Subject: Percutaneous Image-guided Lumbar Decompression (PILD) for Lumbar Spinal Stenosis (LSS)

Number: 199

Title: 10089

Release Date: July 11, 2017

Effective Date: December 7, 2016

Implementation Date: August 11, 2017

Special Notes: Transmittals 196 and 3787, dated May 26, 2017, is being rescinded and replaced by Transmittals 199 and 3805 dated, July 11, 2017 to update references in the CPM and NCD manuals and to add clarifying language. In the NCD manual, the reference to Pub 100-04, Chapter 32, and Section 68 needs to be changed to Section 69. In the CPM manual, the reference in Pub. 100-04, Chapter 32, Section 68 needs to be changed to Section 69 and clarifying language needs to be added to indicate that CMS will cover procedure code 0275T for PILD only when the procedure is performed within any other CED approved randomized and non-blinded clinical trial. All other information remains the same.

 

  • Post author
    Lacy Gaskins