Does 31649 require prior authorization?

No, 31649 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 31649?

Medicare facility rate: $61.79. Non-facility rate: $71.81. Work RVU: 1.40.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

1.40

Facility

$61.79

Non-Facility

$71.81

Objective measures of exercise capacity (6‑minute walk distance [6MWD], cycle ergometry) and documentation of baseline exercise tolerance; many trials used 6MWD and exercise testing as selection/endpoint measures.
Documentation of prior optimized medical therapy, enrollment/completion of pulmonary rehabilitation prior to consideration of BLVR/valve procedures (NICE and trial inclusion criteria require prior pulmonary rehabilitation and optimized pharmacotherapy).
Assessment of gas trapping/hyperinflation (e.g., TLC >100% predicted, RV >150% predicted or RV >175% for some BTVA recommendations) when selecting patients for BLVR.
Assessment and documentation that the patient is a non‑smoker or has ceased smoking (many trials required non‑smokers), and documentation of ability to tolerate bronchoscopic procedures/anesthesia.

ICD-10 codes listed as covered diagnoses for the above procedures: J43.0 - J43.9 (Emphysema [except due to alpha-1-antitrypsin deficiency]) and J93.81 - J93.9 (Other pneumothorax and air leak [Recurrence of pneumothorax]).
CPT/HCPCS codes covered if selection criteria are met (examples listed in policy): 31647, 31648, 31649, 31651, 32141, 32491, 32655, 32672, G0302, G0303, G0304, G0305 (see policy for full code descriptions and coding details).
Lung volume reduction surgery (LVRS) for patients with advanced chronic obstructive pulmonary disease (COPD) due to emphysema (selected patients).
LVRS provides a survival advantage for patients with predominantly upper‑lobe emphysema and low baseline exercise capacity (as shown in the NETT trial).
Bilateral LVRS may produce greater spirometric improvement than unilateral procedures in appropriate candidates.
Bullectomy (surgical resection of bullae) for giant bullous emphysema (GBE) in which single or multiple large bullae encompass ~30% or more of a hemithorax and compress/replace functional lung tissue.

HUMANA-ENDOBRONCHIAL-VALVES-FOR-EMPHYSEMA-MA — Endobronchial Valves for Emphysema - Medicare Advantage

AETNA-CPB-0160 — Lung Denervation Therapy and Lung Volume Reduction Surgery

BCBSIL-SUR706.015 — Bronchial Valves

BCBSMT-SUR706.015 — Bronchial Valves

BCBSNM-SUR706.015 — Bronchial Valves

Ask Verity about documentation requirements, denial risks, or coverage in your state.