CommercialCoverageMedium impact
Electromagnetic Navigation Bronchoscopy 6.01.40
Excellus BlueCross BlueShield·Pulmonology, Oncology, Thoracic Surgery·Lungs (Respiratory)
Effective date
Jan 22, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has established new medical necessity criteria for Electromagnetic Navigation Bronchoscopy (ENB) effective January 22, 2026. The policy defines specific covered indications including highly suspicious solitary pulmonary nodules with accessibility issues, lung lesions with co-existing cancer affecting staging, and fiducial marker placement for non-surgical radiation therapy candidates.
Action Required
By January 22, 2026: Billing team must update prior authorization requirements for CPT codes 31626 and 31627 to ensure medical necessity documentation meets Excellus BCBS criteria. Providers must document one of the approved indications: (1) highly suspicious solitary pulmonary nodule with accessibility issues or patient risk factors, (2) lung lesions with co-existing cancer affecting staging, or (3) fiducial marker placement for non-surgical radiation candidates. Update encounter forms and EMR templates to capture required documentation elements. Claims not meeting medical necessity criteria will be denied.