LCD/NCD Portal

NCD150.11

 

THERMAL INTRADISCAL PROCEDURES (TIPS)

 

 

Effective Date of this Version

1/5/2009

 

Benefit Category

• Physicians' Services.

• Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

 

Item/Service Description

A. General

• Percutaneous thermal intradiscal procedures (TIPs) involve the insertion of a catheter(s)/probe(s) in the spinal disc under fluoroscopic guidance for the purpose of producing or applying heat and/or disruption within the disc to relieve low back pain.

• The scope of this national coverage determination on TIPs includes percutaneous intradiscal techniques that employ the use of a radiofrequency energy source or electrothermal energy to apply or create heat and/or disruption within the disc for coagulation and/or decompression of disc material to treat symptomatic patients with annular disruption of a contained herniated disc, to seal annular tears or fissures, or destroy nociceptors for the purpose of relieving pain.

o This includes techniques that use single or multiple probe(s)/catheter(s), which utilize a resistance coil or other delivery system technology, are flexible or rigid, and are placed within the nucleus, the nuclear-annular junction, or the annulus.

• Although not intended to be an all-inclusive list, TIPs are commonly identified as intradiscal electrothermal therapy (IDET), intradiscal thermal annuloplasty (IDTA), percutaneous intradiscal radiofrequency thermocoagulation (PIRFT), radiofrequency annuloplasty (RA), intradiscal biacuplasty (IDB), percutaneous (or plasma) disc decompression (PDD) or coblation, or targeted disc decompression (TDD).

o At times, TIPs are identified or labeled based on the name of the catheter/probe that is used (e.g., SpineCath, discTRODE, SpineWand, Accutherm, or TransDiscal electrodes). Each technique or device has its own protocol for application of the therapy.

o Percutaneous disc decompression or nucleoplasty procedures that do not utilize a radiofrequency energy source or electrothermal energy (such as the disc decompressor procedure or laser procedure) are NOT within the scope of this NCD.

 

Indications and Limitations of Coverage

 

Nationally Covered Indications

• N/A

 

Nationally Non-Covered Indications

• Effective for services performed on or after September 29, 2008, the Centers for Medicare and Medicaid Services have determined that TIPs are NOT reasonable and necessary for the treatment of low back pain.

• Therefore, TIPs, which include procedures that employ the use of a radiofrequency energy source or electrothermal energy to apply or create heat and/or disruption within the disc for the treatment of low back pain, are NONCOVERED.

 

Other

N/A

 

Claims Processing Instructions

• TN 1646 (Medicare Claims Processing)

 

Coverage Transmittal Link

http://www.cms.gov/transmittals/downloads/R97NCD.pdf

 

National Coverage Analyses (NCAs)

• This NCD has been or is currently being reviewed under the National Coverage Determination process.

• The following are existing associations with NCAs, from the National Coverage Analyses database.

• Original consideration for Thermal Intradiscal Procedures (CAG-00387N)

 

 

Medicare NCD Link