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25.2.3.2 Lung Volume Reduction Surgery (LVRS)
Prior authorization for lung volume reduction surgery (LVRS) is mandatory and approved only if the physician indicates the LVRS will be performed in an approved Texas Medicaid LVRS facility and certified under the Disease Specific Care Certification Program for LVRS by the Joint Commission and identified by the National Heart, Lung, and Blood Institute. If the facility indicated on the original authorization request is not a Medicaid-approved transplant facility, the physician needs to designate a different approved facility before the authorization is given. TMHP issues prior authorization for dates within the facility approval period.
Note: If the client is a Texas Medicaid managed care client, all prior authorizations for transplants will need to be obtained from the client's health plan. If the LVRS has not been performed by the end of the authorization period, physicians need to apply for an extension. Fax inquiries for authorization extensions to TMHP Special Medical Prior Authorization at 1-512-514-4213.
An outpatient facility must bill using revenue code B-469.
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