2025 HCPCS code G0276

Blinded procedure for lumbar stenosis; percutaneous image-guided lumbar decompression (PILD), or placebo control, in an approved coverage with evidence development (CED) clinical trial.

This code should only be reported for procedures performed within the context of a CMS-approved clinical trial.Outside of this context, code 0275T should be utilized instead.

Modifiers may be applicable depending on the specifics of the procedure within the trial. Consult the trial protocol and coding guidelines for applicable modifiers.

Medical necessity for G0276 is established by the patient's participation in a CMS-approved, blinded, randomized, controlled clinical trial for PILD as a treatment for lumbar spinal stenosis. The trial must have a placebo control arm.

The clinical responsibility rests with the physician(s) conducting the clinical trial.This involves patient selection, performing the PILD or placebo procedure, and managing post-procedural care within the trial protocol.

IMPORTANT 0275T (Percutaneous laminotomy or laminectomy) is used for PILD procedures outside of the specified clinical trial.

In simple words: This code is used when a patient takes part in a special study (clinical trial) for a minimally invasive back surgery (PILD) to treat a narrowed spinal canal.The patient either receives the actual surgery or a fake one (placebo) without knowing which one.This code is only used for this specific type of study.

HCPCS code G0276 represents a blinded, randomized, controlled clinical trial for percutaneous image-guided lumbar decompression (PILD) or placebo control for lumbar spinal stenosis under coverage with evidence development (CED).The patient receives either PILD (restoring disc space using imaging guidance and minimally invasive access) or a simulated procedure (placebo).This code is exclusively for use within the specified trial parameters. For procedures outside this trial, code 0275T is applicable.

Example 1: A 65-year-old female with lumbar spinal stenosis participates in a blinded, randomized, controlled CED clinical trial for PILD. She undergoes the PILD procedure; G0276 is reported., A 72-year-old male with lumbar spinal stenosis participates in the same CED clinical trial but receives a placebo procedure instead of PILD; G0276 is reported., A 58-year-old patient with LSS is enrolled in the trial.Due to an unforeseen complication, the PILD procedure is modified and a different approach is used. G0276 is reported with appropriate modifiers.

* Detailed clinical notes documenting the patient's diagnosis (Lumbar Spinal Stenosis) and clinical trial enrollment.* Documentation outlining that this procedure is part of a blinded, randomized, controlled trial.* Specific documentation detailing the procedure performed (PILD or placebo).* Pre- and post-operative imaging reports showing the extent of spinal stenosis.

** This code is highly specific to a particular type of clinical trial; accurate coding requires close adherence to the trial protocol and associated guidelines.

  • Payment Status: Active
  • Modifier TC rule: Not applicable, as this code represents an entire clinical trial procedure, not a specific technical component.
  • Fee Schedule : Fee schedules vary based on payer and year. Consult payer-specific fee schedules for the relevant period.
  • Specialties:Neurosurgery, Orthopedic Surgery, Pain Management
  • Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center
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