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Lung Volume Reduction Surgery
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MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Provider Types Affected
All Medicare providers who submit claims to Medicare carriers or fiscal intermediaries (FIs) for Lung Volume Reduction Surgery (LVRS)
Provider Action Needed
Impact to You
CR4149 outlines the newly modified requirements for facilities eligible to perform LVRS and the updated manual paragraphs on the National Emphysema Treatment Trail (NETT) published by the Centers for Medicare & Medicaid Services (CMS).
What You Need to Know
Beginning November 17, 2005, CMS allows facilities certified under the Disease Specific Care Certification Program for LVRS by the Joint Commission of Health Care Organizations (Joint Commission) to be Medicare approved LVRS facilities. Hospitals that are Medicare approved for lung or heart-lung transplant will continue to be approved for LVRS. NETT facilities are no longer automatically approved for LVRS. These hospitals will have 18 months to become approved under one of the other existing mechanisms.
What You Need to Do
Be aware of the new requirements for LVRS facilities.
Background
Between 1997 and 2003, CMS covered LVRS when provided under the protocol of the National Emphysema Treatment Trial (NETT), a clinical trial sponsored by the National Heart Lung and Blood Institute and CMS. On January 1, 2004, a national coverage determination became effective that allowed coverage of LVRS, outside of a trial, for patients with certain clinical indications and when performed at approved hospitals (CR2688).
CR4149 updates the requirements for hospitals to become approved as Medicare LVRS facilities. CMS will maintain an updated listing of approved LVRS facilities at http://cms.hhs.gov/MedicareApprovedFacilitie/04_lvrs.asp#TopOfPage  on the CMS Web site.
Note: The NETT has ended and CR4149 removes outdated language from the Medicare National Coverage Determinations Manual that refers to coverage for LVRS under the protocol of that trial. |
Medicare will consider LVRS reasonable and necessary only when the following requirements are met:
Effective for services performed on or after November 17, 2005, LVRS is performed at a facility that is:
- Certified by the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) under the LVRS Disease Specific Care Certification Program (program standards and requirements as printed in the Joint Commission’s October 25, 2004, Disease Specific Care Certification Program packet); or
- Performed at facilities that are Medicare-approved for lung or heart-lung transplantation.
CMS further determines that LVRS performed between January 1, 2004 and May 17, 2007, may be performed at facilities that:
- Were approved by the National Heart Lung and Blood Institute to participate in the National Emphysema Treatment Trial;
- Are Medicare-approved for lung or heart-lung transplantation.
Implementation
The implementation date for the instruction is March 2, 2006.
Additional Information
The official instructions issued to your carrier/intermediary regarding this change can be found at http://cms.hhs.gov/transmittals/downloads/R768CP.pdf  on the CMS Web site. The changes to Publication 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 4, § 240.1, are attached to CR4149.
If you have questions, please contact your carrier/intermediary at their toll-free number which may be found at http://www.cms.hhs.gov/MedlearnProducts/downloads/CallCenterTollNumDirectory.pdf on the CMS Web site.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
For more information, visit the Medlearn Matters Web page at http://www.cms.hhs.gov/MedlearnMattersArticles.
Pub. 100-4, Transmittal# 768, CR# 4149
Medlearn Matters Number: MM 4149
Related CR Release Date: December 2, 2005
Effective Date: November 17, 2005
Implementation Date: March 2, 2006
Posted: 12/29/2005
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CPT codes, descriptions, and other data only are copyright 2005 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.
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