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Reimbursement Briefs: CMS Restricts Coverage For PILD Spine Surgery; OIG News

Medicare will only cover percutaneous image-guided lumbar decompression as part of qualifying clinical trials under a final national coverage determination. OIG scrutinizes Medicare Administrative Contractor performance and local coverage determination inconsistencies. More reimbursement briefs.

A CMS final decision memo released Jan. 9 announces that percutaneous image-guided lumbar decompression (PILD) for lumbar spinal stenosis is not reasonable and necessary, but will be covered by Medicare when provided in a clinical study through coverage-with-evidence development for beneficiaries with lumbar spinal stenosis who are enrolled in an approved clinical study that meets certain criteria.

To qualify for Medicare payment under the new policy, a trial of PILD for lumbar spinal stenosis must address one or more aspects of whether PILD provides a clinically meaningful...

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