CMS Pub. 100-04, ch. 4, § 310

Lung Volume Reduction Surgery (LVRS) (also known as reduction pneumoplasty, lung

shaving, or lung contouring) is an invasive surgical procedure to reduce the volume of a

hyperinflated lung in order to allow the underlying compressed lung to expand, and thus,

establish improved respiratory function.

Effective for 'from' dates of service on or after January 1, 2004, Medicare will cover

LVRS under certain conditions as described in §240 of the Pub. 100-03, “National

Coverage Determinations”.

LVRS can only be performed in the facilities listed on the following website:

http://www.cms.gov/Medicare/Medicare-General-

Information/MedicareApprovedFacilitie/Lung-Volume-Reduction-Surgery-LVRS.html.

LVRS is an inpatient procedure. However pre- and post- operative services are

performed on an outpatient basis and must be performed at one of the facilities certified

to do so. These procedures are paid under the Outpatient Prospective Payment System

(OPPS), except for hospitals located in Maryland.

Medicare previously only covered LVRS as part of the National Emphysema Treatment

Trial (NETT). The study was limited to 18 hospitals, and patients were randomized into

two arms, either medical management and LVRS or medical management. The study

was conducted by The National Heart, Lung, and Blood Institute of the National

Institutes of Health and coordinated by Johns Hopkins University (JHU). Hospital claims

for patients in the NETT were identified by the presence of Condition Code EY. The

JHU instructed hospitals of the correct billing procedures for billing claims under the

NETT.