Lung Denervation Therapy and Lung Volume Reduction Surgery

Aetna covers LVRS only for patients meeting strict NETT‑based selection criteria, considers bullectomy medically necessary for a single large bulla causing significant respiratory compromise (FEV1 <50%), VATS blebectomy/bullectomy for prevention of recurrent pneumothorax, and FDA‑approved endobronchial valves (Spiration, Zephyr) for severe emphysema with hyperinflation and little/no collateral ventilation; LVRS is excluded for alpha‑1 antitrypsin deficiency, clinically significant bronchiectasis, giant bulla >1/3 lung, pulmonary hypertension, prior lobectomy/LVRS, recurrent infective sputum production, and other listed contraindications. Key LVRS requirements: bilateral emphysema on CT; FEV1 ≤45% predicted (with age adjustments), TLC ≥100% and RV ≥150% predicted, PaO2 ≥45 mm Hg, PaCO2 ≤60 mm Hg, six‑minute walk >140 m, nicotine abstinence (cotinine ≤13.7 ng/mL or COHb ≤2.5%), and exclusion of patients with FEV1 ≤20% plus DLCO ≤20% or homogeneous emphysema or high maximal workload per protocol.