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Official Description

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
Short Descr Pild/placebo control clin tr
Coverage Special coverage instructions apply
Pricing Indicator(s) 13 – Physician Fee Schedule - Price established by carriers (e.G., not otherwise classified, individual determination, carrier discretion)
MPI A – Not applicable, as HCPCS priced under one methodology
ASC Payment Group Code YY – 1/01/2015
Processing Note SEE 150.13 MEDICARE NATIONAL COVERAGE DETERMINATIONS MANUAL CHAPTER 1, PART 2; ALSO CR 8757, TRANSMITTAL 167 DATED MAY 16, 2014.
BETOS P6D – Minor procedures - other (non-Medicare fee schedule)
TOS Code(s) 1 – Medical care
Added Date 1/1/2015
Status Code Restricted Coverage
Global Days 000 - Endoscopic or Minor Procedure
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 2 - 150% payment adjustment does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight.
MUE 1
MUE Not applicable/unspecified.
OTS Orthotic No
Q0 Investigational clinical service provided in a clinical research study that is in an approved clinical research study
Date
Action
Notes
2015-01-01 Added Code added 1/1/2015
2014-01-09 Added Added
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