Medicare Advantage

Medical Policy

Title:

Percutaneous Image-Guided Lumbar Decompression (PILD) for Spinal Stenosis

Policy #:

MA11.097f

Policy

This policy uses coverage criteria developed solely based on applicable Medicare statutes, regulations, NCDs, LCDs, CMS manuals and other applicable Medicare coverage documents.

In accordance with Medicare, percutaneous image-guided lumbar decompression (PILD) for lumbar spinal stenosis is considered experimental/investigational and, therefore, not covered, with the exception of Coverage with Evidence Development.

COVERAGE WITH EVIDENCE DEVELOPMENT (CED)

PILD for lumbar spinal stenosis is eligible for coverage consideration for individuals who meet all the requirements of Original Medicare's CED provisions for PILD, including but not limited to CED-approved devices (i.e., Vertos Medical, VertiFlex^®, Inc.) and are enrolled in a Medicare-approved clinical study.

BILLING REQUIREMENTS

Claims for PILD for lumbar spinal stenosis for individuals enrolled in a CED clinical trial should be submitted to the Medicare Advantage plan.

Providers must report Modifier Q0 with CPT procedure codes 62330 and 62331 or HCPCS code G0276 to represent investigational clinical service provided in a Centers for Medicare & Medicaid Services (CMS)-approved clinical research study.

Guidelines

This policy is consistent with Medicare’s coverage determination for percutaneous image-guided lumbar decompression (PILD) for lumbar spinal stenosis. The Company’s payment methodology may differ from Medicare.

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable Evidence of Coverage, PILD for lumbar spinal stenosis is covered under the applicable medical benefits of the Company's Medicare Advantage products when the requirements for Coverage with Evidence Development listed in this medical policy are met.

PILD procedures performed when the requirements for Coverage with Evidence Development listed in this medical policy are met should be billed with G0276 for clinical trials that are blinded, randomized, controlled, and contain a placebo procedure control arm. CPT code 62330 and 62331 should be billed for other clinical trials when the requirements of Original Medicare's Coverage of Evidence Development are met.

Services that are experimental/investigational are excluded for the Company’s Medicare Advantage products. Therefore, they are not eligible for reimbursement consideration.

Description

Percutaneous image-guided lumbar decompression (PILD) for lumbar spinal stenosis (LSS) is a procedure that has been proposed as a treatment for symptomatic LSS unresponsive to conservative therapy. PILD involves a posterior decompression of the lumbar spine performed under indirect image guidance without any direct visualization of the surgical area. It is generally described as a noninvasive procedure using specially designed instruments to percutaneously remove a portion of the lamina and debulk the ligamentum flavum. The procedure is performed under x-ray guidance (e.g., fluoroscopic, computed tomography) with the assistance of contrast media to identify and monitor the compressed area via epiduragram.

LSS is defined as the reduction of the cross-sectional area, or narrowing, of the lumbar spinal canal. It is usually caused by spinal degenerative conditions and is commonly found to be asymptomatic. LSS is subclassified into three broad categories: central stenosis, lateral stenosis, and spondylolisthesis. Central stenosis refers to a narrowing of the spinal canal across the anteroposterior diameter, the transverse diameter, or both. Symptomatic individuals typically present with symptoms of radicular leg pain or with neurogenic claudication (i.e., pain in the buttocks or legs on walking or standing that resolves with sitting down or lumbar flexion).

Although lumbar laminectomy is often considered the gold standard surgical treatment for LSS, PILD has been proposed as an alternative surgical treatment. However, there is a lack of adequately designed peer-reviewed literature or guidance from relevant medical societies to establish its safety and effectiveness. There is a need for additional clinical studies with sufficient follow-up, sample size, and relevant comparative control groups to establish the appropriateness of PILD for the treatment of central LSS.

Two devices (Vertos Medical and VertiFlex^®, Inc.) have been approved by the Centers for Medicare & Medicaid Services (CMS) for Coverage with Evidence Development (CED). Additionally, as part of a Medicare Claims study, the Vertos Medical device is being investigated in a prospective, longitudinal analysis to evaluate individuals with LSS who are treated with a minimally invasive lumber decompression (MILD) procedure compared with individuals who receive an alternative interspinous process decompression (IPD) procedure.

References

Centers for Medicare & Medicaid Services (CMS). Coverage with Evidence Development approved clinical trials for percutaneous image-guided lumbar decompression (PILD) for lumbar spinal stenosis (LSS). [CMS Web site]. Available at: https://www.cms.gov/medicare/coverage/evidence/lumbar-spinal-stenosis. Accessed April 6, 2026.

Centers for Medicare & Medicaid Services (CMS). Decision Memo for Percutaneous Image-guided Lumbar Decompression for Lumbar Spinal Stenosis (CAG-00433R). [CMS Web site]. 12/07/2016. Available at: https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&NCAId=284. Accessed April 6, 2026.

Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD) for Percutaneous Image-guided Lumbar Decompression for Lumbar Spinal Stenosis. (150.13) [CMS Web site]. 12/07/2016. Available at: https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=358&ncdver=2&bc=AAAAgAAAAAAA&. Accessed April 6, 2026.

Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD) on Routine Costs in Clinical Trials (310.1) [CMS Web site]. 05/27/2024. Available at: https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=1&ncdver=3&DocID=310.1. Accessed April 6, 2026.

Centers for Medicare & Medicaid Services (CMS). Medicare Managed Care Manual. Chapter 4: Benefits and Beneficiary Protections. [CMS Web site]. 04/22/2016. Available at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c04.pdf. Accessed April 6, 2026

Centers for Medicare & Medicaid Services (CMS). Pub100-04 Medicare Claims Processing Transmittal 1418. New HCPCS Modifiers when Billing for Patient Care in Clinical Research Studies. [CMS Web site]. 01/18/2008. Available at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1418cp.pdf. Accessed April 6, 2026.

US Food and Drug Administration (FDA). Center for Devices and Radiological Health. Vertos Medical mild® Device Kit. 510(k) summary. [FDA Web site]. 02/04/10. Available at: http://www.accessdata.fda.gov/cdrh_docs/pdf9/K093062.pdf. Accessed April 6, 2026.

US National Library of Medicine. MILD® Percutaneous Image-Guided Lumbar Decompression: A Medicare Claims Study. 03/07/2017. Updated 03/27/2026. Available at: https://clinicaltrials.gov/ct2/show/NCT03072927. Accessed on April 6, 2026.

Coding

CPT Procedure Code Number(s)

THE FOLLOWING CODE REPRESENTS PERCUTANEOUS IMAGE-GUIDED MINIMALLY INVASIVE LUMBAR DECOMPRESSION FOR SPINAL STENOSIS WHEN PERFORMED IN A COVERAGE WITH EVIDENCE DEVELOPMENT CLINICAL TRIAL:

62330, 62331

ICD - 10 Procedure Code Number(s)

N/A

ICD - 10 Diagnosis Code Number(s)

N/A

HCPCS Level II Code Number(s)

THE FOLLOWING CODE REPRESENTS PERCUTANEOUS IMAGE-GUIDED MINIMALLY INVASIVE LUMBAR DECOMPRESSION FOR SPINAL STENOSIS WHEN PERFORMED IN A COVERAGE WITH EVIDENCE DEVELOPMENT CLINICAL TRIAL WITH BLINDING, AND RANDOMIZATION, CONTAINING A PLACEBO PROCEDURE CONTROL ARM:

G0276 Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar decompression (pild) or placebo-control, performed in an approved coverage with evidence development (ced) clinical trial

Revenue Code Number(s)

N/A

MPMiscCodesNarrativesPub
Modifiers

THE FOLLOWING MODIFIER MUST BE APPENDED TO 62330, 62331, G0276 IN ORDER TO BE CONSIDERED FOR REIMBURSEMENT:

Q0 Investigational clinical service provided in a clinical research study that is in an approved clinical research study

Coding and Billing Requirements

Inclusion of a code in this policy does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

Cross Reference

Policy History

Revisions From MA11.097f:

06/10/2026

This policy has been reviewed and reissued to communicate the Company's continuing position on percutaneous image-guided lumbar decompression (PILD) for spinal stenosis.

01/01/2026

Inclusion of a policy in a Code Update memo does not imply that a full review of the policy was completed at this time.

This policy has been identified and updated for the CPT code update effective 01/01/2026.

The following CPT code has been termed from the policy: 0275T

The following CPT codes have been added to the policy as Experimental/Investigational:

62330, 62331

Revisions From MA11.097e:

04/02/2025

This policy has been reviewed and reissued to communicate the Company's continuing position on percutaneous image-guided lumbar decompression (PILD) for spinal stenosis.

04/17/2024	This policy has been reviewed and reissued to communicate the Company's continuing position on percutaneous image-guided lumbar decompression (PILD) for spinal stenosis.
01/01/2024	Effective 01/01/2024 this policy applies to New Jersey Medicare Advantage (MA) lines of business.
05/31/2023	This policy has been reissued in accordance with the Company's annual review process.
09/29/2022	The version of this policy will become effective 08/29/2022. The following clarification has been made to the policy billing requirements in alignment with Medicare guidelines: Providers must report Modifier Q0 with CPT procedure code 0275t and HCPCS code G0276 to represent investigational clinical service provided in a Centers for Medicare & Medicaid Services (CMS) approved clinical research study

Revisions From MA11.097d:

06/15/2022	The policy has been reviewed and reissued to communicate the Company's continuing position on Percutaneous Image-Guided Lumbar Decompression (PILD) for Spinal Stenosis.
05/19/2021	The policy has been reviewed and reissued to communicate the Company's continuing position on Percutaneous Image-Guided Lumbar Decompression (PILD) for Spinal Stenosis.
03/11/2020	The policy has been reviewed and reissued to communicate the Company's continuing position on Percutaneous Image-Guided Lumbar Decompression (PILD) for Spinal Stenosis.
12/16/2019	This version of the policy will become effective 12/16/2019. The policy has been updated to include language identifying the applicable CMS approved devices part of Coverage with Evidence Development. The policy intent remains unchanged.

Revisions From MA11.097c:

04/15/2019

This version of the policy will become effective 04/15/2019.

The policy has been updated to be consistent with Medicare and allow prospective longitudinal studies to be eligible for Coverage with Evidence Development. The policy intent remains unchanged.

Revisions From MA11.097b:

04/11/2018	This policy has undergone a routine review, no revisions have been made.
06/21/2017	This policy has been reissued in accordance with the Company's annual review process.
01/01/2017	This version of the policy will become effective 01/01/2017. The CPT narrative has been revised in this policy for the following code: 0275T

Revisions From MA11.097a:

04/13/2016	The policy has been reviewed and reissued to communicate the Company’s continuing position on percutaneous image-guided lumbar decompression (PILD) for spinal stenosis
02/18/2015	This policy was reviewed and updated to add HCPCS code G0276. Medicare notes that this code should be billed for PILD procedures performed when the requirements for Coverage with Evidence Development are met and the clinical trial is blinded, randomized, and controlled, and contains a placebo procedure control arm.

Revisions From MA11.097:

01/01/2015

This is a new policy.

Version Effective Date:

1/1/2026

Version Issued Date:

1/5/2026

Version Reissued Date:

6/10/2026