UnitedHealthcare (Commercial) · percutaneous image guided lumbar decompression

v1verified 2026-07-24manual-pull source

✗ investigational / not covered · commercial

Criteria checklist

0 of 5 ticked

Indications

enumerated: yes
covered:
investigational:
- percutaneous image-guided lumbar decompression (PILD) and MILD — unproven and not medically necessary due to insufficient evidence of efficacy

Conservative care

required: not stated in the policy
note: n/a — not covered

Trial

required: no
min duration days: not stated in the policy
success criteria: not stated in the policy
threshold is binding: no

Psychological evaluation

required: no
must clear: no
note posture: n/a

Quantity limits

applies: no

Payor-specific notes

UHC (2026T0640H) deems both PILD and MILD unproven/not medically necessary. The policy uses the 2026 Cat-I codes 62330 (+62331) — the replacement for the deleted 0275T — plus 62380 (endoscopic); it lists Medicare's CED code G0276 but still deems the service unproven for commercial members. More restrictive than Medicare (PILD covered only under CED). From the fetched UHC PDF.

Ticks are a documentation aid — nothing is stored; they reset on reload.

Dot phrase

UHC (2026T0640H) deems PILD and MILD **unproven/not medically necessary**.

.MILDUHC

This patient would be a candidate for percutaneous image-guided lumbar decompression, but
PILD/MILD is not a covered benefit under this plan: UHC 2026T0640H deems it unproven and not
medically necessary. My clinical rationale is documented here: *** . Alternatives have been
discussed with the patient. Any appeal must contest the unproven determination itself.

Cautions

Medicare covers PILD only under Coverage with Evidence Development, billed G0276.
CPT: 62330/62331 (replaced 0275T 2026-01-01); 62380 endoscopic. Regenerate if `uhc-commercial-mild.md` `version` advances.

Prior-auth pathway

required: not stated in the policy
note: n/a — denied as unproven

Provenance

authority:
- type: commercial_policy
- id: UHC 2026T0640H
- title: Minimally Invasive Spine Surgery Procedures
- applies because: UHC commercial policy governs MILD/PILD
source: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/minimally-invasive-spine-surgery.pdf
archived copy: sources/uhc_mis-spine_2026-02-01.pdf (sha256 435fc9237ae0… — kept in the content repo, not served here)
effective: 2026-02-01 · payor last reviewed: 2026-02-01 · we verified: 2026-07-24 · v1

Report an issue with this cell

Change history

2026-07-24commercial cells: re-verify 27 source PDFs by SHA-256 (Carelon/eviCore/UHC/Cigna) - all unchanged vs committed archive; last_verified -> 2026-07-24 3615c231f0
2026-06-30Archive commercial source PDFs into sources/ + wire source_file/source_hash c5466694c8
2026-06-29Add commercial MILD/PILD cells (all investigational) + correct Medicare MILD CPT 4c790f8264