Medicare AdvantagePrior AuthMedium impact
MA11.097f, Percutaneous Image-Guided Lumbar Decompression (PILD) for Spinal Stenosis
Independence Blue Cross·Neurosurgery, Orthopedics, Pain Management +1 more·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Policy MA11.097f establishes coverage guidelines for Percutaneous Image-Guided Lumbar Decompression (PILD) as a treatment for spinal stenosis under Medicare Advantage plans, effective January 1, 2026. The billing team must implement prior authorization requirements and ensure proper coding compliance for this procedure.
Action Required
By December 15, 2025: Billing team must review the complete MA11.097f policy text to identify specific CPT/HCPCS codes, prior authorization requirements, and medical necessity criteria for PILD procedures. Update billing software to enforce prior authorization requirements per policy specifications. Notify providers performing lumbar decompression procedures of any new documentation or authorization requirements. Obtain the full policy document from the provided URL to extract specific billing codes and authorization workflows, as they are not detailed in the policy announcement. Failure to obtain prior authorization before service delivery will result in claim denials on Medicare Advantage plans.