0274T — Prq lamot/lam dcmpr crv/thrc
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Use validated outcome measures to demonstrate whether a condition improves or worsens.
- Document the magnitude of change and that the change is clinically significant.
- Provide evidence of balance of benefits and harms (length of life, quality of life, functional ability).
- Clinical documentation of neurogenic claudication symptoms and symptom duration (≥3 months).
Key Coverage Criteria
- Percutaneous image-guided minimally invasive decompression for decompression of the central spinal canal in patients with symptomatic spinal stenosis.
- Patients with hypertrophy of the ligamentum flavum causing central canal stenosis who are candidates for percutaneous, image-guided decompression.
- Guided minimally invasive lumbar decompression as an alternative to posterior decompression procedures for lumbar spinal stenosis causing narrowing around the spinal cord with compression of the spinal cord and/or nerve roots.
- Lumbar spinal stenosis with neurogenic claudication (leg pain, numbness, or weakness worsened by standing or walking and relieved by sitting or leaning forward).
- Cervical or thoracic spinal stenosis presenting with neck pain and radiculopathy of the shoulder/arm, commonly from degenerative disc disease or disc herniation.
- Symptomatic neural element compression due to degenerative changes (e.g., ligamentum flavum hypertrophy, intervertebral disc bulging, facet joint arthropathy) contributing to clinically significant stenosis.
6 Active Policies
BCBSIL-SUR712.035 — Image-Guided Minimally Invasive Decompression for Spinal Stenosis
BCBSMT-SUR712.035 — Image-Guided Minimally Invasive Decompression for Spinal Stenosis
BCBSNM-SUR712.035 — Image-Guided Minimally Invasive Decompression for Spinal Stenosis
BCBSOK-SUR712.035 — Image-Guided Minimally Invasive Decompression for Spinal Stenosis
REGENCE-SUR176 — Image-Guided Minimally Invasive Decompression (IG-MSD) for Spinal Stenosis
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.