Medicare AdvantageCoverageMedium impact
Endobronchial Valve Therapy for Emphysema - Medicare Advantage (Revised)
Humana·Pulmonology·Medicare Advantage
We identified it
Jun 30, 2026
Summary
Humana Medicare Advantage has issued a revised policy on Endobronchial Valve (EBV) Therapy for emphysema treatment. This policy establishes coverage criteria for bronchoscopic lung volume reduction (BLVR) as a minimally invasive treatment option for select patients with severe emphysema. The billing team must obtain and review the full policy details to determine specific prior authorization requirements, covered diagnoses, patient eligibility criteria, and applicable billing codes.
Action Required
IMMEDIATELY: Billing team must request the FULL POLICY DOCUMENT from Humana (not just the summary) at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a5698b4 to identify: (1) Specific CPT/HCPCS codes for EBV placement and BLVR procedures, (2) Prior authorization requirements and process, (3) Medical necessity documentation requirements, (4) Effective date of this revised policy, (5) Any changes from the previous EBV policy. Once obtained, update billing software, encounter templates, and provider education materials accordingly. Without the full policy, claims for EBV procedures risk denial. Flag this policy in your system as REVISED (1 day old) to ensure the old version is superseded.