Does G0302 require prior authorization?

No, G0302 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for G0302?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`G0302`, Pre-operative pulmonary surgery services for preparation for lvrs, complete

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Objective measures of exercise capacity (6‑minute walk distance [6MWD], cycle ergometry) and documentation of baseline exercise tolerance; many trials used 6MWD and exercise testing as selection/endpoint measures.
Documentation of prior optimized medical therapy, enrollment/completion of pulmonary rehabilitation prior to consideration of BLVR/valve procedures (NICE and trial inclusion criteria require prior pulmonary rehabilitation and optimized pharmacotherapy).

Assessment of gas trapping/hyperinflation (e.g., TLC >100% predicted, RV >150% predicted or RV >175% for some BTVA recommendations) when selecting patients for BLVR.

Assessment and documentation that the patient is a non‑smoker or has ceased smoking (many trials required non‑smokers), and documentation of ability to tolerate bronchoscopic procedures/anesthesia.

Multidisciplinary team assessment documented (recommendation that patient selection be done by a team including chest physician, radiologist, thoracic surgeon, and respiratory nurse for EBV procedures per NICE).

For EBV/coil/vapor therapies: documentation of collateral ventilation assessment (radiologic fissure integrity and/or physiologic endoscopic balloon occlusion/flow assessment) where indicated.

Key Coverage Criteria

ICD-10 codes listed as covered diagnoses for the above procedures: J43.0 - J43.9 (Emphysema [except due to alpha-1-antitrypsin deficiency]) and J93.81 - J93.9 (Other pneumothorax and air leak [Recurrence of pneumothorax]).
CPT/HCPCS codes covered if selection criteria are met (examples listed in policy): 31647, 31648, 31649, 31651, 32141, 32491, 32655, 32672, G0302, G0303, G0304, G0305 (see policy for full code descriptions and coding details).
Lung volume reduction surgery (LVRS) for patients with advanced chronic obstructive pulmonary disease (COPD) due to emphysema (selected patients).
LVRS provides a survival advantage for patients with predominantly upper‑lobe emphysema and low baseline exercise capacity (as shown in the NETT trial).
Bilateral LVRS may produce greater spirometric improvement than unilateral procedures in appropriate candidates.
Bullectomy (surgical resection of bullae) for giant bullous emphysema (GBE) in which single or multiple large bullae encompass ~30% or more of a hemithorax and compress/replace functional lung tissue.

6 Active Policies

ANTHEM-CG-REHAB-03, Pulmonary Rehabilitation

AETNA-CPB-0160, Lung Denervation Therapy and Lung Volume Reduction Surgery

BCBSIL-THE803.025, Outpatient Pulmonary Rehabilitation

BCBSMT-THE803.025, Outpatient Pulmonary Rehabilitation

BCBSNM-THE803.025, Outpatient Pulmonary Rehabilitation

BCBSOK-THE803.025, Outpatient Pulmonary Rehabilitation

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G0302, Pre-operative pulmonary surgery services for preparation for lvrs, complete