CommercialCoverageLow impact
Lung Volume Reduction Surgery for Severe Emphysema
Blue Cross & Blue Shield of Mississippi·MS · Pulmonology, Cardiothoracic Surgery·Medical Policy
We identified it
Jun 20, 2026
Summary
This is a new Blue Cross Blue Shield Mississippi policy defining medical necessity criteria for lung volume reduction surgery for severe emphysema patients. The policy establishes specific patient selection criteria including age restrictions, lung function parameters, and medical requirements that must be met for coverage approval.
Action Required
Immediately: Review patient cases for lung volume reduction surgery to ensure all nine criteria are documented before submission to BCBS Mississippi, including FEV1 values, upper-lobe emphysema confirmation, smoking cessation documentation, and completion of pulmonary rehabilitation. Update prior authorization checklists to include all specified medical necessity requirements to prevent claim denials.