`G0304` Pre-op service lvrs 1-9 dos

Pre-operative pulmonary surgery services for preparation for lvrs, 1 to 9 days of services

Medicare coverage: Carrier judgment
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 1 units per day (policy), rationale: Code Descriptor / CPT Instruction
Outpatient hospital: max 1 units per day (policy), rationale: Code Descriptor / CPT Instruction

Medicare pricing for G0304

Physician Fee Schedule (CY 2026, RVU26D)

Status X: statutory exclusion, not paid under the PFS.

Payer policies and prior authorization for G0304

1 of 1 payer prior-auth lists that name G0304 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Blue Cross and Blue Shield of Texas	Texas PA exemption (gold card), outpatient, fully insured	TX	prior auth required	Gold-card exemption available	Jul 1, 2026	BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range)

Payer coverage policies that name G0304

G0304 appears in 6 coverage policies from Aetna, Anthem, Blue Cross Blue Shield of Massachusetts, Blue Shield of California, BlueCross BlueShield of South Carolina.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Lung Denervation Therapy and Lung Volume Reduction Surgery (0160) Spiration Valve System	covered if criteria are met	Mar 26, 2026	payer document
Anthem	Pulmonary Rehabilitation (CG-REHAB-03)	covered if criteria are met (range G0302-G0304)	May 14, 2026	payer document
Blue Cross Blue Shield of Massachusetts	Lung Volume Reduction Surgery for Severe Emphysema (364)	listed, no stance		payer document
Blue Cross Blue Shield of Massachusetts	Outpatient Pulmonary Rehabilitation (136)	listed, no stance		payer document
Blue Shield of California	Lung Volume Reduction Surgery for Severe Emphysema (7.01.71)	listed, no stance		payer document
BlueCross BlueShield of South Carolina	Lung Volume Reduction Surgery for Severe Emphysema (CAM 70171)	listed, no stance	Jul 1, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

AZ: $353.64 (outpatient_hospital), effective Oct 1, 2021
ND: $0.00 (physician), effective Aug 1, 2026
VT: $289.74 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $165.02 (outpatient_hospital_apc, Ambulatory Surgical Centers), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

G0304 Pre-op service lvrs 1-9 dos