Medicare Benefits Schedule - Note TN.8.142

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Category 3 - THERAPEUTIC PROCEDURES

TN.8.142

Spinal Decompression - Items 51011 to 51015

Items 51011 to 51015 are for services which include discectomy, decompression of central spinal canal by laminectomy or partial corpectomy (vertebral spurs and osteophytes; less than 50% of the vertebral body), and decompression of the subfacetal recess, the exit foramen and far lateral (intertransverse) space. 

Items 51011 to 51015 should only be used for direct decompression, and not where decompression occurs as an indirect result of the procedure performed. Direct decompression enables the cord and exiting nerve roots to be visualised, and the neural structures decompressed.

Through the anterior approach to the cervical spine, direct decompression can be performed with the resection of the annulus and posterior longitudinal ligament (PLL) and/or uncovertebral joints, the removal of herniated nucleus pulposa (HNP) or osteophytes. In the anterior lumbar interbody space, direct decompression can occur with resection of the posterior annulus and PLL, and removal of the HNP or osteophytes to visualise the cauda equina and decompress the neural structures.

With XLIF and OLIF, decompression can only be indirect.

For decompression procedures, only one item is selected from 51011 to 51015.

For posterolateral spinal fusion without instrumentation, if a decompression procedure is combined with the fusion, two items numbers can be selected: one from 51011 to 51015 and one from 51031 to 51036.

For posterolateral spinal fusion with instrumentation, two item numbers can be selected: one from 51020 to 51026 and one from 51031 to 51036. If decompression is also performed, three items can be selected: one from 51011 to 51015, one from 51020 to 51026 and one from 51031 to 51036.

For instrumented spinal fusion with interbody and posterolateral bone graft (with or without cages) and decompression, four item numbers can be selected: one from one from 51011 to 51015, one from 51020 to 51026, one from 51031 to 51036 and one from 51041 to 51045.

If more than 50% of a vertebral body is resected (piecemeal vertebrectomy) an item from 51051 to 51059 can be selected in addition to an item from 51011 to 51015.

Items 51011 to 51015 can be used when the purpose of the laminectomy is exposure or posterior spinal release.

Related Items: 51011 51012 51013 51014 51015


Related Items

Category 3 - THERAPEUTIC PROCEDURES

51011

51011 - Additional Information

Item Start Date:
01-Nov-2018
Description Updated:
01-Nov-2021
Schedule Fee Updated:
01-Jul-2022

Direct spinal decompression or exposure (via a partial or a total laminectomy or a partial vertebrectomy), or a posterior spinal release, one motion segment, not being a service associated with a service to which item 51012, 51013, 51014 or 51015 applies (H) 

(Anaes.) (Assist.)

Fee: $1,517.55 Benefit: 75% = $1,138.20

(See para TN.8.141, TN.8.142 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

51012

51012 - Additional Information

Item Start Date:
01-Nov-2018
Description Updated:
01-Nov-2021
Schedule Fee Updated:
01-Jul-2022

Direct spinal decompression or exposure (via a partial or a total laminectomy or a partial vertebrectomy), or a posterior spinal release, 2 motion segments, not being a service associated with a service to which item 51011, 51013, 51014 or 51015 applies (H) 

(Anaes.) (Assist.)

Fee: $2,023.15 Benefit: 75% = $1,517.40

(See para TN.8.141, TN.8.142 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

51013

51013 - Additional Information

Item Start Date:
01-Nov-2018
Description Updated:
01-Nov-2021
Schedule Fee Updated:
01-Jul-2022

Direct spinal decompression or exposure (via a partial or a total laminectomy or a partial vertebrectomy), or a posterior spinal release, 3 motion segments, not being a service associated with a service to which item 51011, 51012, 51014 or 51015 applies (H) 

(Anaes.) (Assist.)

Fee: $2,529.05 Benefit: 75% = $1,896.80

(See para TN.8.141, TN.8.142 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

51014

51014 - Additional Information

Item Start Date:
01-Nov-2018
Description Updated:
01-Nov-2021
Schedule Fee Updated:
01-Jul-2022

Direct spinal decompression or exposure (via a partial or a total laminectomy or a partial vertebrectomy), or a posterior spinal release, 4 motion segments, not being a service associated with a service to which item 51011, 51012, 51013 or 51015 applies (H) 

(Anaes.) (Assist.)

Fee: $3,034.85 Benefit: 75% = $2,276.15

(See para TN.8.141, TN.8.142 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

51015

51015 - Additional Information

Item Start Date:
01-Nov-2018
Description Updated:
01-Nov-2021
Schedule Fee Updated:
01-Jul-2022

Direct spinal decompression or exposure (via a partial or a total laminectomy or a partial vertebrectomy), or a posterior spinal release, more than 4 motion segments, not being a service associated with a service to which item 51011, 51012, 51013 or 51014 applies (H) 

(Anaes.) (Assist.)

Fee: $3,540.65 Benefit: 75% = $2,655.50

(See para TN.8.141, TN.8.142 of explanatory notes to this Category)


Legend

  • Assist - Addition/Deletion of (Assist.)
  • Amend - Amended Description
  • Anaes - Anaesthetic Values Amended
  • Emsn - EMSN Change
  • Fee - Fee Amended
  • Renum - Item Number Change (renumbered)
  • New - New Item
  • NewMin - New Item (previous Ministerial Determination)
  • Qfe - QFE Change