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Endobronchial Ultrasound for Diagnosis and Staging of Lung Cancer

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) may be considered medically necessary for the evaluation of peripheral pulmonary lesions in patients with suspected lung cancer when the following criteria are met:
Tissue biopsy of the peripheral pulmonary lesion is required for diagnosis (see Policy Guidelines section);

The peripheral pulmonary lesion is not accessible using standard bronchoscopic techniques.

EBUS-TBNA is considered medically necessary for mediastinal staging in patients with diagnosed lung cancer when the following criteria are met:

The patient is suitable and willing to undergo specific treatment for lung cancer, with either curative or palliative intent (see Policy Guidelines section);

Tissue biopsy of abnormal mediastinal lymph nodes seen on imaging is required for staging and specific treatment planning (see Policy Guidelines section);

Abnormal lymph nodes seen on imaging are accessible by EBUS-TBNA.

Endobronchial ultrasound is considered not medically necessary for diagnosis and staging of lung cancer when the above criteria are not met.

Endobronchial ultrasound is considered investigational for all other indications.

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