ΨΥΧΗΣ ΙΑΤΡΕΙΟΝ

LCD ID #L28991 AxiaLIF Spine Surgery a NONCOVERED Service

Local Coverage Determination (LCD) for AxiaLIF Spine Surgery

The presacral interbody technique (CPT codes 0195T, 196T, 0309T and 22586) (e.g. AxiaLIF) is noted as a noncovered service.

 

Some of the emerging techniques and associated tools (devices, spinal instrumentation, bone graft substitutes, etc.) are considered investigational and this LCD does NOT endorse such procedure.

 

 •  NOTE: An Advance Beneficiary

    Notice (ABN) is required for items

    and services not covered by

    Medicare due to being considered

    not medically reasonable and

    necessary.

           ◦  The beneficiary should be

               thoroughly educated about the

               benefits and risks of this item

               or service.

           ◦  If such notice is not given,

              providers may not shift financial

              liability for such items or services

              to beneficiaries should a claim for

              such items or services be denied

              by Medicare.

 0195T - Arthrodesis, pre-sacral interbody

                 technique, including instrumentation,

                 imaging (when performed), and

                 discectomy to prepare interspace,

                 lumbar; single interspace

 

 0196T - Arthrodesis, pre-sacral interbody

                technique, including instrumentation,

                imaging (when performed), and

                discectomy to prepare interspace,

                lumbar; each additional interspace

                (List separately in addition to code for

                primary procedure)

 

0309T - Arthrodesis, pre-sacral interbody

               technique, including disc space

               preparation, discectomy, with

               posterior instrumentation, with image

               guidance, includes bone graft, when

               performed, lumbar, L4-L5 interspace

               (List separately in addition to code for

               primary procedure)

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