Medicare Compliance & Reimbursement

After years of non-coverage, an emphysema treatment is about to get the green light.

Health care providers will soon be able to bill for lung volume reduction surgery, after years of non-coverage under Medicare. In an Aug. 20 decision memo, the Centers for Medicare & Medicaid Services says it plans to make LVRS available to certain Medicare beneficiaries with severe emphysema. Patients will have to meet criteria outlined in the results of the National Emphysema Treatment Trial, the largest study to date of bilateral LVRS as a treatment for severe emphysema. LVRS involves the surgical removal of diseased portions of a lung to make way for remaining, healthy lung tissue. Heads up: In its decision memo, CMS notes that it plans to develop accreditation standards for LVRS, and that, ultimately, only accredited facilities will be able to bill for the procedure. To see the memo, go to http://cms.hhs.gov/mcd/viewdecisionmemo.asp?id=96. Lesson Learned: Watch for the release of a national coverage determination from CMS that will open the door to billing Medicare for LVRS procedures.