Image-Guided Minimally Invasive Decompression (IG-MLD) for Spinal Stenosis
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This policy governs Blue Cross Blue Shield of North Carolina coverage for image-guided minimally invasive decompression procedures (eg, mild®) for treatment of spinal stenosis, describing evidence, coding, and coverage stance for providers and members.
Deleted terminated code 0275T and added CPT codes 62330 and 62331 to the Billing/Coding Section effective 1/1/2026.
Coverage Determination and Rationale
Coverage determination and evidence rationale
Coverage stance and rationale
BCBSNC does not provide coverage for investigational services or procedures.
Well-designed trials with relevant control groups are needed to determine net health outcome.
The devices and the percutaneous image-guided minimally invasive lumbar decompression procedure (mild®) are intended specifically for resection of hypertrophic ligamentum flavum and small laminar bone to treat central lumbar spinal stenosis. The procedure is performed under fluoroscopic guidance using a specialized cannula and single-use tools to remove tissue from the perilaminar/interlaminar space and ventral aspect of the lamina.
The mild® tool kit and the procedure are not intended for treatment of disc pathology or for procedures near the lateral neural elements; the devices remain dorsal to the dura and are contraindicated for disc procedures or use near lateral neural elements.
Image-guided minimally invasive spinal decompression (IG-MLD; mild®) is considered investigational for all applications. As such, Blue Cross Blue Shield of North Carolina does not provide coverage for IG-MLD and will not reimburse services deemed investigational.
Billing and Coding
| 62330 | Epidural injection; single lumbar or sacral level, diagnostic or therapeutic |
| 62331 | Epidural injection; each additional lumbar or sacral level (List separately in addition to code for primary procedure) |
| 0274T | Per-cutaneous image-guided lumbar decompression for ligamentous decompression (eg, mild), includes imaging guidance |
| G0276 | Percutaneous decompression of lumbar spinal canal for treatment of central spinal stenosis (historical/other billing code) |
Provider Requirements and Actions
No step therapy requirements specified
No step therapy rules are specified in this policy.
Medical records may be requested; letters alone may be insufficient
BCBSNC may request medical records for determination of medical necessity; letters of support or explanation alone are not sufficient unless they include all specific information needed to make the determination.
Coverage denial for investigational procedures (IG-MLD)
Requests for image-guided minimally invasive lumbar decompression (IG-MLD) will be denied as investigational; BCBSNC does not provide coverage for investigational services or procedures.
Clinical Background
Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal that can produce neurogenic claudication — leg pain, numbness, or weakness that is typically worsened by standing or walking and relieved by sitting or flexion. Degenerative changes such as ligamentum flavum hypertrophy, disc bulge, and facet arthropathy commonly contribute to central canal narrowing.
Image-guided minimally invasive lumbar decompression (IG-MLD; mild®) is an ultra–minimally invasive, percutaneous, fluoroscopically guided decompression technique designed to remove hypertrophic ligamentum flavum and small amounts of lamina to decompress the central canal. The procedure uses contrast under fluoroscopy and specialized single-use instruments introduced through a 6-gauge cannula to perform tissue and bone sculpting without endoscopic or microscopic visualization.
Because the procedure targets the central canal, the mild® approach cannot address nerve root compression from lateral recess or foraminal stenosis or disc herniation; the devices are not intended for use near lateral neural elements. Given current evidence and policy review, IG-MLD is considered investigational and is not covered by BCBSNC.
Definitions and Device Status
Policy Updates
Deleted terminated code 0275T and added CPT codes 62330 and 62331 to the Billing/Coding section, effective 1/1/2026.
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