The Centers for Medicare and Medicaid Services (CMS) issued a final decision on January 9, 2014, not to cover percutaneous image-guided lumbar decompression (PILD) for lumbar spinal stenosis (LSS). CMS has deter- mined that PILD is not reasonable and necessary and Medicare will only pay for it when provided in a clinical study under certain conditions through its Medicare Coverage with Evidence Development (CED) policy.

On Nov. 11, 2013, the AANS, CNS and the AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves sent a letter, available at http://bit.ly/1dsKy6P, opposing

coverage, stating, “overall our field of neurosurgery has not embraced the use of this procedure due to concerns regarding its effectiveness as compared to our current surgical options.” The letter further notes that the “present literature…is of low quality and demonstrates that this technique is not indicated in patients with a significant element of bony stenosis, lateral recess stenosis, or foraminal stenosis.” A copy of the CMS final decision memorandum is on the CMS website at: http://go.cms.gov/1j7AALW.