Endobronchial Valves for Emphysema - Medicare Advantage

This policy covers endobronchial valve placement (bronchoscopic lung volume reduction) using FDA‑approved devices (e.g., Spiration, Zephyr) for treatment of severe emphysema in patients who remain symptomatic despite maximal medical therapy. Coverage is limited to patients meeting all selection criteria — including target lobes with low collateral ventilation, RV ≥150% predicted (≥200% if homogeneous disease), post‑bronchodilator FEV1 15–45% predicted, TLC ≥100%, DLCO >20% predicted, 6‑minute walk ≥100 m, BMI 15–35 kg/m2, arterial blood gases without severe hypercapnia (PaCO2 <50 mm Hg) or hypoxemia (PaO2 >45 mm Hg), clinical stability on ≤20 mg prednisone, recent pulmonary rehabilitation — and excludes those who do not meet these physiologic/clinical thresholds; hospitalization for monitoring and Medicare reasonable/necessary requirements apply.

"BMI documentation showing value >15 and <35 kg/m2"