Interspinous Process Decompression System
WPS Medicare Part B will cover the implantation of an Interspinous Process Decompression System in accordance to the FDA approved indications. This system will be covered for the treatment of patients aged 50 or older suffering from neurogenic intermittent claudication secondary to a confirmed diagnosis of lumbar stenosis with x-ray, MRI and/or CT evidence of thickened ligamentum flavum, narrowed lateral recess and/or central canal narrowing. This system is indicated for those patients with moderately impaired physical function who experience relief in flexion from their symptoms of leg/buttock/groin pain, with or without back pain, and have undergone a regimen of at least 6 months of nonoperative treatment. This device may be implanted at one or two lumbar levels in patients in whom operative treatment is indicated at no more than two levels. The medical record must document the above requirements. Only FDA approved systems (e.g. X STOP) will be covered.
Claims for the implantation of these systems should use the CPT codes 0171T Insertion of posterior spinous process distraction device, lumbar; single level and 0172T Insertion of posterior spinous process distraction device, lumbar; each additional level. These codes became effective 01/01/2007. Place the name of the FDA approved decompression system in item 19 of the CMS-1500 claim form or its electronic equivalent. The claim must also have both the ICD-9 code for spinal stenosis 724.02 Spinal stenosis, lumbar region and the ICD-9 code for neurogenic intermittent claudication 349.9 Unspecified disorders of the nervous system.
Page Last Updated: Thursday, 18-Mar-2010 05:55:31 CDT
