CMS Pub. 100-04, ch. 32, § 330.1

(PILD) for Lumbar Spinal Stenosis (LSS) on Professional Claims

(Rev. 13709; Issued:04-02-26, Effective: 06-02-26; Implementation: 06-02-26)

For claims with dates of service on or after January 9, 2014, PILD (procedure code 0275T - end date 12/31/25) is a

covered service when billed as part of a clinical trial approved by CMS.

The description for CPT 0275T end date 12/31/25 is : “Percutaneous laminotomy/laminectomy (intralaminar approach)

for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or

foraminotomy”, any method, under indirect image guidance (e.g., fluoroscopic, CT), with or without the use of an

endoscope, single or multiple levels, unilateral or bilateral; lumbar” .

CPT 62330 describes percutaneous image-guided lumbar decompression (PILD) for spinal stenosis, involving the

removal of the ligamentum flavum and laminotomy, with imaging (CT or fluoroscopy) and epidurography.

Effective January 1, 2026, 62330 is replacing the former CPT code (0275T – end date effective 12/31/25).

For claims with dates of service on or after January 1, 2015, PILD (procedure code G0276) is a covered service when

billed as part of a clinical trial approved by CMS. HCPCS G0276 is “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”.

Effective for dates of service on or after December 7, 2016, Medicare will cover PILD under CED for beneficiaries with

LSS who are enrolled in a CMS -approved prospective longitudinal study for PILD procedures using a FDA -

approved/cleared device that completed a CMS-approved randomized, controlled clinical trial (RCT) that met the criteria

listed in the January 2014 NCD (see CR 8757, transmittal # 2959, dated May 16, 2014).

The claim may only contain one of these procedure codes, not both. To report G0276, the procedure must be performed

within a CMS approved CED clinical trial that is randomized, blinded, and includes a placebo control arm of the trial.

CMS will cover procedure code 0275T (end date effective 12/31/25) for PILD only when the procedure is performed

within any other CED approved clinical trial. Regardless of the type of CED approved clinical trial (e.g. G0276 vs

0275T (end date effective 12/31/25 ), PILD is only covered when billed for the ICD-9 diagnosis of 724.01-724.03 or the

ICD-10 diagnosis of M48.05-M48.07, when billed in places of service 19 (Off Campus-Outpatient Hospital (effective

01/01/16), 22 (Outpatient) or 24 (Ambulatory Surgical Center), when billed along with V70.7 (ICD-9) or Z00.6 (ICD-

10) in either the primary/secondary positions, and when billed with modifier Q0.

Additionally, per Transmittal 2805 (Change Request 8401), issued October 30, 2013, all claims for clinical trials must

contain the 8-digit clinical trial identifier number.

The following message(s) shall be used to notify providers of return situations that may occur:

Professional Claims 8-digit Clinical Trial Number

For PILD claims with procedure code 0275T (end date 12/31/25) with dates of service on or after January 9, 2014, or

claims with procedure code G0276 with dates of service on or after January 1, 2015, contractors shall pay for PILD only

when billed with the numeric, 8-digit clinical trial identifier number preceded by the two alpha characters “CT” when

placed in Field 19 of paper Form CMS-1500, or when entered without the “CT” prefix in the electronic 837P in Loop

2300 REF02 (REF01=P4). Claims for PILD which are billed without an 8-digit clinical trial identifier number shall be

returned as un-processable.

Note: Effective January 1, 2026, CPT 62330 is replacing the former CPT code (0275T – end date effective 12/31/25).

The following messages shall be used when Medicare contractors return PILD claims billed without an 8-digit clinical

trial identifier number as un-processable:

Claims Adjustment Reason Code 16: “Claim/service lacks information or has submission/billing error(s) which is

needed for adjudication”.

Remittance Advice Remark Code N721: “This service is only covered when performed as part of a clinical trial.”

Remittance Advice Remark Code MA50: “Missing/incomplete/invalid Investigational Device Exemption number or

Clinical Trial number.”

Remittance Advice Remark Code N704: "Alert: You may not appeal this decision but can resubmit this claim/service

with corrected information if warranted."

Professional Claims Place of Service – 19 (effective 01/01/16), 22 or 24 CMS

For PILD claims with procedure code 62330 effective 01/01/26 or for claims with procedure code G0276 with dates of

service on or after January 1, 2015, contractors shall pay for PILD for LSS claims only when billed in place of service

19, 22 or 24. Claims for PILD which are billed in any other place of service shall be returned as un-processable.

The following messages shall be used when Medicare contractors return PILD claims not billed in place of service 19,

22 or 24:

Claims Adjustment Reason Code 58: “Treatment was deemed by the payer to have been rendered in an inappropriate or

invalid place of service.”

Remittance Advice Remark Code N704: "Alert: You may not appeal this decision but can resubmit this claim/service

with corrected information if warranted."

Professional Claims Modifier – Q0

For PILD claims with procedure code 0275T has an end date 12/31/25, with dates of service on or after January 9, 2014,

(note: 0275T is being replaced with 62330 effective 01/01/26) or for claims with procedure code G0276 with dates of

service on or after January 1, 2015, contractors shall pay for PILD for LSS claims only when billed with modifier Q0.

Claims for PILD which are billed without modifier Q0 shall be returned as un-processable.

The following messages shall be used when Medicare contractors return PILD claims billed without modifier Q0 as un-processable:

Claims Adjustment Reason Code 4: “The procedure code is inconsistent with the modifier used or a required modifier is

missing.”

Remittance Advice Remark Code N657: “This should be billed with the appropriate code for these services."

Remittance Advice Remark Code N704: "Alert: You may not appeal this decision but can resubmit this claim/service

with corrected information if warranted."

Non-covered Diagnosis

For PILD claims with procedure code 0275T end date 12/31/25, with dates of service on or after January 9, 2014 (note:

0275T is being replaced with 62330 effective 01/01/26), or for claims with procedure code G0276 with dates of service

on or after January 1, 2015, contractors shall pay for PILD for LSS claims only when billed with the ICD-9 diagnosis of

724.01-724.03 or the ICD-10 diagnosis of M48.05-M48.07.

The following messages shall be used when Medicare contractors return PILD claims, billed without the covered

diagnosis, as un-processable:

Claims Adjustment Reason Code B22: “This payment is adjusted based on the diagnosis.”

Remittance Advice Remark Code N704: "Alert: You may not appeal this decision but can resubmit this claim/service

with corrected information if warranted."

Clinical Trial Diagnosis

For PILD claims with procedure code 0275T and end date 12/31/25 with dates of service on or after January 9, 2014,

(note 0275T is being replaced with 62330 effective 01/01/26), or for claims with procedure code G0276 with dates of

service on or after January 1, 2015, contractors shall pay for PILD only when billed with the ICD-9 diagnosis of V70.7

(ICD-9) or Z00.6 (ICD-10) in either the primary or secondary positions. The following messages shall be used when

Medicare contractors return PILD claims, billed without the clinical trial diagnosis, as un-processable:

Claims Adjustment Reason Code B22: “This payment is adjusted based on the diagnosis.”

Remittance Advice Remark Code N704: "Alert: You may not appeal this decision but can resubmit this claim/service

with corrected information if warranted."