CommercialCoverageHigh impact
Lung Denervation Therapy and Lung Volume Reduction Surgery (CPB 0160, reviewed 2026-03-26)
Aetna·Pulmonology, Cardiothoracic Surgery, Critical Care·Surgery
Effective date
Mar 26, 2026
We identified it
Aug 17, 2026
Summary
Aetna updated its coverage policy for lung denervation therapy and lung volume reduction surgery (CPB 0160), effective 2026-03-26. The policy clarifies medical necessity criteria for LVRS, bullectomy, and FDA-approved endobronchial valves, while designating targeted lung denervation (dNerva system), bronchoscopic thermal vapor ablation, biologic lung volume reduction, and thoracoscopic laser bullectomy as experimental/investigational and not covered. Billing teams must immediately verify that claims for these procedures include proper prior authorization and meet the detailed selection criteria outlined in the policy.
Action Required
By 2026-03-26: (1) Billing team must update claim submission rules to require prior authorization for CPT codes 31647, 31648, 31649, 31651 (endobronchial valve placement/removal), 32141, 32491, 32655, 32672 (LVRS and bullectomy procedures). (2) Implement edits in billing software to reject claims for experimental procedures: CPT 0781T and 0782T (targeted lung denervation), thoracoscopic laser bullectomy, bronchoscopic thermal vapor ablation, and biologic lung volume reduction systems - flag as non-covered. (3) Providers and clinical staff must document that LVRS candidates meet ALL selection criteria from policy (FEV1 ≤45% predicted, CT evidence of bilateral emphysema, no smoking for 4+ months, specific blood gas/lung capacity values, six-minute walk >140 meters) and have NO exclusion criteria (alpha-1 deficiency, bronchiectasis, giant bullae >1/3 lung volume, O2 >6L/min, pulmonary hypertension, etc.). (4) Update prior authorization forms and encounter templates to capture required pre-operative workup documentation. (5) Front desk staff must alert providers to collect baseline pulmonary function tests, blood gas values, and imaging before scheduling surgery consultations. Failure to comply will result in claim denials for non-covered experimental procedures and retroactive recoupment for non-compliant LVRS claims.