Bronchial Valves

This policy covers bronchoscopic placement of FDA‑approved endobronchial/bronchial valves (Zephyr® or Spiration®) for lung volume reduction in selected patients with emphysema. Coverage is limited to patients meeting strict criteria (age 40–75, BMI <35 kg/m2, non‑smoker ≥4 months, FEV1 15%–45% predicted, 6‑minute walk 100–500 m, stable on ≤20 mg/day prednisone) with heterogeneous emphysema and requires verification of little-to-no collateral ventilation (Chartis or SeleCT) immediately prior to placement; procedures are excluded if any criterion or major contraindication is present (eg, prior LVRS/transplant, homogeneous disease, active infection, large bullae >30%, uncontrolled cardiac/pulmonary disease, or inability to safely stop anticoagulation).

"Placement of an FDA‑approved bronchial valve (Zephyr® Endobronchial Valve System or Spiration® Valve System) for treatment of emphysema when all the following are met: confirmed diagnosis of emphys..."