Does G0276 require prior authorization?

No, G0276 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for G0276?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 6.99.

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`G0276`, Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

6.99

Facility

N/A

Non-Facility

N/A

Documentation Required

Medical records documentation may be required to assess whether the member meets the clinical criteria for coverage, but it does not guarantee coverage; reference member plan documents and guidelines.
No explicit documentation requirements (e.g., required medical records, test results, or specific clinical notes) are specified in this policy.

From Instructions for Use: "When deciding coverage, the member specific benefit plan document must be referenced as the terms of the member specific benefit plan may differ from the standard plan. In the event of a conflict, the member specific benefit plan document governs. Before using this policy, please check the member specific benefit plan document and any applicable federal or state mandates."

From Instructions for Use: "This Medical Policy may also be applied to Medicare Advantage plans in certain instances. In the absence of a Medicare National Coverage Determination (NCD), Local Coverage Determination (LCD), or other Medicare coverage guidance, CMS allows a Medicare Advantage Organization (MAO) to create its own coverage determinations, using objective evidence-based rationale relying on authoritative evidence (Medicare IOM Pub. No. 100-16, Ch. 4, §90.5)."

Key Coverage Criteria

Cover Routine Patient Costs for a Qualifying Individual participating in an Approved Clinical Trial as required by PPACA for plan years starting on/after 2014; benefits include reasonable and necessary items/services to prevent, diagnose, and treat complications arising from participation.
No explicit "Covered Indications" or "Medically Necessary" indications are provided in this policy document.
Coverage decisions are to be determined by the member specific benefit plan document (see Instructions for Use).
Epiduroscopy / epidural lysis of adhesions: proposed for diagnosis/treatment of intractable LBP (including failed back surgery syndrome) by visualizing and lysing adhesions and injecting medications (insufficient high-quality evidence to support routine clinical use).
Kyphoplasty (balloon-assisted vertebroplasty): restore bone height for painful osteoporotic compression fractures (OVCFs); NICE and other assessments note kyphoplasty may be a reasonable alternative to vertebroplasty for recent fractures.
Sacropasty: injection of PMMA into sacrum for sacral insufficiency fractures (SIFs) in osteoporotic patients to stabilize fracture and relieve pain (developing indication).

15 Active Policies

UHC-POL-clinical-trials, Clinical Trials

UHC-POL-minimally-invasive-spine-surgery, Minimally Invasive Spine Surgery Procedures

AETNA-CPB-0016, Back Pain - Invasive Procedures

BCBSIL-ADM1001.027, Clinical Trial Treatment or Therapy

BCBSIL-SUR712.035, Image-Guided Minimally Invasive Decompression for Spinal Stenosis

BCBSMT-ADM1001.027, Clinical Trial Treatment or Therapy

BCBSMT-SUR712.035, Image-Guided Minimally Invasive Decompression for Spinal Stenosis

BCBSNM-ADM1001.027, Clinical Trial Treatment or Therapy

BCBSNM-SUR712.035, Image-Guided Minimally Invasive Decompression for Spinal Stenosis

BCBSOK-ADM1001.027, Clinical Trial Treatment or Therapy

BCBSOK-SUR712.035, Image-Guided Minimally Invasive Decompression for Spinal Stenosis

UMR-POL-UMR-clinical-trials, Clinical Trials

UMR-POL-UMR-minimally-invasive-spine-surgery, Minimally Invasive Spine Surgery Procedures

SUREST-POL-SUREST-clinical-trials, Clinical Trials

SUREST-POL-SUREST-minimally-invasive-spine-surgery, Minimally Invasive Spine Surgery Procedures

`G0276`, Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

15 Active Policies

Related Codes

Have a follow-up question?

G0276, Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

15 Active Policies

Related Codes

Have a follow-up question?

`G0276`, Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar