Therapy for pulmonary conditions is designed to alleviate respiratory symptoms experienced by patients with pulmonary disease.  This therapy is directed toward thinning and mobilizing secretions for removal from the bronchial tree by either expectoration or suction.

Postural Drainage Procedures and Pulmonary Exercises – NCD 240.7
In most cases, postural drainage procedures (94667, 94668, 97124) and pulmonary exercises (G0237 – G0239) can be carried out safely and effectively by nursing personnel. However, in some cases patients may have acute or severe pulmonary conditions involving complex situations in which these procedures or exercises require the knowledge and skills of a physical therapist or a respiratory therapist. Therefore, if the attending physician determines as part of his/her plan of treatment that for the safe and effective administration of such services the procedures or exercises in question need to be performed by a physical therapist, the services of such a therapist constitute covered physical therapy when provided as an inpatient hospital service, extended care service, home health service, or outpatient physical therapy service.

NOTE:

Physical therapy furnished in the outpatient department of a hospital is covered under the outpatient physical therapy benefit.

If the attending physician determines that the services should be performed by a respiratory therapist, the services of such a therapist constitute covered respiratory therapy when provided as an inpatient hospital service, outpatient hospital service, or extended care service, assuming that such services are furnished to the skilled nursing facility by a hospital with which the facility has a transfer agreement. Postural drainage procedures and pulmonary exercises are also covered when furnished by a physical therapist or a respiratory therapist as incident to a physician’s professional service.

Heat Treatment, Including the Use of Diathermy and Ultrasound for Pulmonary Conditions – NCD 240.3
There is no physiological rationale or valid scientific documentation of effectiveness of diathermy (97024) or ultrasound heat treatments (97035) for asthma, bronchitis, or any other pulmonary condition and for such purpose this treatment cannot be considered reasonable and necessary.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Title XVIII of the Social Security Act, Section 1862(a)(7). This section excludes routine physical examinations.

Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury.

Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider for any claim that lacks the necessary information to process the claim.

CMS On-Line Manual 100-03, Sections 240.3, 240.7