National Coverage Analysis (NCA) Tracking Sheet

Lung Volume Reduction Surgery

CAG-00115R2

Issue

CMS currently covers Lung Volume Reduction Surgery (LVRS) for certain subgroups of patients with severe emphysema.  This National Coverage Determination became effective January 1, 2004.  Due to the complexity of the procedure and the level of illness of the patients, CMS requires that patients undergo surgery at Medicare approved lung transplant hospitals or hospitals that participated in the National Emphysema Treatment Trial.  CMS used these requirements as a temporary proxy since guidelines or standards for hospitals were not available for this particular procedure.  In the previous policy, CMS called for an accreditation process and announced that when a process became available the facility requirement would change. 

This reconsideration will use the NCD process to review available accreditation standards to determine if they are sufficient to substitute for the Medicare facility requirement for LVRS.  The reconsideration will include a review of the Joint Commission for the Accreditation of Healthcare Organizations (Joint Commission) standards for LVRS facilities.

Benefit Category

No Benefit Category

Requestor Information

Requestor Name Requestor Letter
The Joint Commission for the Accreditation of Healthcare Facilities (Joint Commission) View Letter
N/A

Important Dates

Formal Request Accepted and Review Initiated
02/17/2005
Expected NCA Completion Date
11/17/2005
Public Comment Period
02/17/2005 - 03/17/2005
Proposed Decision Memo Due Date
Proposed Decision Memo Released
08/18/2005
Proposed Decision Memo Public Comment Period
08/18/2005 - 09/18/2005
Decision Memo Released
11/17/2005
Comments for this NCA
View Public Comments

Contacts

Lead Analysts
JoAnna Baldwin
Lead Medical Officers
Carlos Cano, MD

Medicare Benefit Category Determination Date

Actions Taken

February 17, 2005

CMS opens this reconsideration for review of available standards for LVRS facility requirements. The Joint Commission Standards [PDF, 370KB] are included in this review process.

August 18, 2005

The proposed decision memorandum is now available for review and 30 days of public comment.

November 17, 2005

The final decision memorandum  is posted.