CommercialAdministrativeLow impact
11.16.09, Bronchial Valves
Independence Blue Cross·Pulmonology, Critical Care, Cardiothoracic Surgery·Medical Policy
We identified it
Jul 9, 2026
Summary
Independence Blue Cross reissued Policy 11.16.09 on 07/08/2026 to reaffirm its continuing coverage position on bronchial valves for severe emphysema treatment. No substantive coverage criteria, billing codes, or medical necessity requirements have changed from the original 04/01/2022 effective date. This is a routine annual review reissuance with no new billing or documentation requirements for the medical team.
Action Required
No immediate action required. This is a routine policy reissuance dated 07/08/2026 that communicates the Company's continuing (unchanged) position on bronchial valve coverage. Billing team should maintain existing prior authorization requirements and medical necessity documentation practices for CPT codes 31647, 31648, and 31649 when billed with emphysema diagnosis codes (J43.0-J43.9). Verify that current system workflows still enforce the eight medical necessity criteria (dyspnea control, pulmonary rehab completion, age 40-75, BMI <35, prednisone ≤20mg daily, FEV1 15-45%, 6MWD ≥100m and <500m, minimal collateral ventilation, and 4-month smoking abstinence) prior to claim submission. No system updates or form modifications are needed.