Endoscopic, Arthroscopic, Laparoscopic, Bronchoscopic and Thoracoscopic Surgery

This policy covers endoscopic (arthroscopic, laparoscopic, bronchoscopic, thoracoscopic) procedures as direct substitutes for corresponding open surgeries when they duplicate the same techniques and patient‑selection criteria, and specifically allows bronchoscopic visualization and occlusion for persistent bronchopleural fistula (BPF) in patients who are not surgical candidates. Coverage is limited to indications that would justify the open approach and to patients who meet selection criteria for the corresponding open procedure, excludes robotic assistance and endoscopic uses that create new indications, and (administratively) the policy is inactive as of its stated end date and not to be used for current claims adjudication.

"Endoscopic, arthroscopic, laparoscopic, bronchoscopic and thoracoscopic procedures when they duplicate the same surgical techniques and principles as the corresponding open procedure and the only d..."