Lung Denervation Therapy and Lung Volume Reduction Surgery — CPB 0160 | AETNA Coverage Update

Aetna modified CPB 0160, its lung denervation therapy and lung volume reduction surgery coverage policy, effective September 26, 2025. Here's what billing teams need to do.

Aetna, a CVS Health company, updated CPB 0160 to reflect current medical necessity criteria for a range of bronchoscopic and thoracoscopic lung procedures. The policy covers procedures billed under CPT codes including 0781T, 0782T, 31647, 31648, 31649, 31651, 32141, 32491, 32655, and 32672, among more than 100 total codes in scope. If your practice performs lung volume reduction surgery (LVRS), bronchial valve placement, targeted lung denervation, or bronchoscopic thermal vapor ablation, this coverage policy change affects your charge capture and prior authorization workflows now.

Quick-Reference Table

Aetna Lung Volume Reduction Surgery and Lung Denervation Coverage Criteria and Medical Necessity Requirements 2025

The Aetna lung denervation therapy and lung volume reduction surgery coverage policy classifies several procedures as medically necessary when specific selection criteria are met. The policy draws a clear line between procedures it covers under defined criteria and procedures it considers experimental or investigational.

CPB 0160 in the Aetna system covers bronchial valve procedures (CPT 31647, 31648, 31649, 31651) and surgical lung volume reduction approaches (CPT 32141, 32491, 32655, 32672) when patients meet appropriate medical necessity thresholds. Targeted lung denervation, billed under CPT 0782T, also appears under the covered category when criteria are satisfied. Bronchoscopic thermal vapor ablation, billed under CPT 0781T, is included in the same grouping.

The real-world implication: every one of these procedures requires documentation showing the patient meets selection criteria before Aetna will consider reimbursement. Submit a claim without that documentation, and you're looking at a claim denial — not a soft edit, a hard denial.

Prior authorization is a central concern here. Procedures at this acuity level — bronchoscopic and thoracoscopic interventions for severe emphysema — almost universally trigger prior auth requirements under Aetna's commercial and Medicare Advantage plans. Confirm prior authorization requirements for each specific procedure code before scheduling, not after.

Whether Aetna prior authorization requirements for lung denervation and LVRS apply to your patient's specific plan depends on the benefit design. Group plans can carve out coverage or add stricter criteria on top of CPB 0160. Check the member's actual plan documents, not just the CPB.

Aetna Lung Denervation and LVRS Exclusions and Non-Covered Indications

CPB 0160 places targeted lung denervation (CPT 0782T) and bronchoscopic thermal vapor ablation (CPT 0781T) in a grouping labeled alongside other procedures subject to selection criteria. The data provided groups these codes under "Bronchoscopic thermal vapor ablation, thoracoscopic bullectomy" — suggesting these procedures sit at the edge of what Aetna considers established versus emerging.

The large block of excision of lung and pleura codes (CPT 32440 through 32488, and 32501 through 32518) appears under "Other CPT codes related to the CPB." These are not listed as covered when selection criteria are met. They're contextually related codes Aetna includes for reference — likely to address claim edits or unbundling scenarios. Don't bill these expecting the same covered status as the primary LVRS codes.

This is the part of CPB 0160 that will generate the most confusion for billing teams. A code appearing in a policy document does not mean it's covered. The group label matters. If you're billing CPT 32440 through 32488 for an Aetna member and expecting reimbursement under this policy, stop and review the actual coverage determination for those codes under the member's plan.

If you're not sure how the "related codes" grouping applies to your specific claims, talk to your compliance officer before the effective date of September 26, 2025 — or before your next claim submission under CPB 0160.

Coverage Indications at a Glance

Aetna Lung Denervation and LVRS Billing Guidelines and Action Items 2025

CPT, HCPCS, and ICD-10 Codes for Lung Denervation and LVRS Under CPB 0160

Covered CPT Codes (When Selection Criteria Are Met)

Bronchoscopic Thermal Vapor Ablation and Targeted Lung Denervation Codes

Other CPT Codes Referenced in CPB 0160 (Not Listed as Covered Under Selection Criteria)

Note: The policy data provided includes 23 additional CPT codes in the "Other CPT codes related to the CPB" group beyond what is listed above. These follow the same pattern — excision of lung and pleura codes not listed as covered under CPB 0160's selection criteria. Review the full policy at Aetna's provider portal for the complete list.

ICD-10-CM and HCPCS code details were not provided in the policy data for this update. Pull the full CPB 0160 from Aetna's provider portal to confirm applicable diagnosis codes before claim submission.