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  • Coverage Of PILD Under the Coverage With Evidence Development
  • Post author
    Lacy Gaskins

Coverage Of PILD Under the Coverage With Evidence Development

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/R200NCD.pdf

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

Number: 200

Title: 10089

Release Date: July 11, 2017

Effective Date: December 7, 2016

Implementation Date: August 11, 2017

Special Notes: Transmittals 199, Pub. 100-03 and 3805, Pub. 100-04, dated July 11, 2017, are being rescinded and replaced by Transmittals 200 and 3811, dated, July 25, 2017, to update references in the Claims Processing Business Requirements and National Coverage Determinations Requirements documents. The reference in both business requirement documents, in the policy section to Pub.100-04, Chapter 32, Section 68 needs to be changed to Section 69. In the Claims Processing Manual, 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 clinical trial. All other information remains the same.

 

  • Post author
    Lacy Gaskins