Electromagnetic Navigation-Guided Bronchoscopy (CPB 0776, reviewed 2026-06-08)

By 2026-06-08: Billing team must update claim submission rules and prior authorization guidelines in billing software to enforce Aetna coverage restrictions. (1) CPT +31627 and HCPCS C7509, C7510, C7511 are COVERED ONLY when medical necessity criteria are met (peripheral nodule diagnosis or transbronchial dye injection); require prior auth documentation confirming one of these two indications. (2) HCPCS C8005 is NOT COVERED and must be flagged for denial; do not bill for non-thermal ablation procedures. (3) Procedures using CPT 0600T, 0601T, or involving cone-beam CT augmented EN-guided bronchoscopy, EN-guided microwave ablation, or trans-bronchial lung cryo-biopsy must be identified and denied as experimental/investigational. (4) ICD-10 codes R91.1 and R91.8 (solitary/other pulmonary nodules) are covered ONLY for diagnostic indications, NOT for ablation or therapeutic purposes. (5) Providers must document in claims which of the two covered indications applies; add a required field to encounter forms. Update denial reason codes in system to reflect experimental status for non-covered procedures. Flag all claims for these four procedures for manual review and denial with explanation of experimental status. Failure to implement will result in inappropriately paid claims for non-covered services.