National Coverage Analysis (NCA) Tracking Sheet

Lung Volume Reduction Surgery

CAG-00115R

Issue

Lung volume reduction surgery (LVRS) is a treatment for the symptoms of emphysema in which approximately 30% of the damaged lung tissue is removed in an attempt to improve the mechanics of respiration.   The surgery is generally performed by either a median sternotomy or video-scope assisted thoracoscopy.

The National Emphysema Treatment Trial (NETT) randomized patients to medical management and medical management plus LVRS.   NIH and CMS initiated this trial jointly as additional randomized, controlled trials to identify the utility of LVRS were lacking.  Now that the trial is complete and the results published, CMS is opening a national coverage determination to assess the provision of LVRS to Medicare beneficiaries.

As pulmonary rehabilitation was an important aspect of the trial protocol, the coverage decision for LVRS will also include a review of pulmonary rehabilitation as a prerequisite for LVRS.

Also, CMS will address the question of appropriate facility criteria for performing LVRS.

Benefit Category

Inpatient Hospital Services
Outpatient Hospital Services Incident to a Physician's Service
Physicians' Services

Requestor Information

Requestor Name Requestor Letter
Internally generated N/A
N/A

Important Dates

Formal Request Accepted and Review Initiated
05/20/2003
Expected NCA Completion Date
08/18/2003
Public Comment Period
06/20/2003 - N/A
Proposed Decision Memo Due Date
Proposed Decision Memo Released
Proposed Decision Memo Public Comment Period
Decision Memo Released
08/20/2003

Contacts

Lead Analysts
JoAnna Baldwin
Lead Medical Officers
Carlos Cano, MD

Medicare Benefit Category Determination Date

Actions Taken

May 20, 2003

NCD opened.   CMS is particularly interested in public comments on the evidence for LVRS, the value of preoperative pulmonary rehabilitation, and the potential for restricting LVRS to certain facilities that meet predefined criteria.

August 20, 2003

Decision memorandum and benefit category determination posted.