April 28, 2011

 

BC-11-04
MS-11-04

To:

All Blue Cross Contracting Providers

From:

Connie Winkley – Education/Communication Coordinator
Institutional Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association

Subject:

Image-Guided Minimally Invasive Lumbar Decompression (IG-MLD) for Spinal Stenosis

Blue Cross and Blue Shield of Kansas has developed a policy based on the Blue Cross and Blue Shield Association (BCBSA) policy for Image-Guided Minimally Invasive Lumbar Decompression (IG-MLD) for Spinal Stenosis.  BCBSA considers this procedure to be Experimental / Investigational (E/I). 

CMS created C9729 code for the above procedure which is effective April 1, 2011 through June 30, 2011. 

Effective July 1, 2011, there will be a CPT category III code (0275T) that is applicable to the above listed procedure.

It is recommended to have the patient complete a Limited Patient Waiver (LPW) form.  These charges will be denied as a provider write-off unless the provider obtains an LPW signed by the patient. By obtaining a signed LPW, the E/I charges will be denied as the patient’s responsibility.  This form is available by clicking on the link below.

http://www.bcbsks.com/CustomerService/Forms/pdf/15-169_limited_pat_waiver.pdf

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