The following guidelines should be used to process claims for IPPB treatments, heat treatments for pulmonary conditions, and postural drainage and pulmonary exercises:

Pressurized or Non-Pressurized Inhalation Treatment (IPPB) (94640, 94664)

1. Pressurized or non-pressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes (code 94640) is a covered service.  This service includes treatment provided with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device.

   The demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device, code 94664, is also covered.

2. IPPB treatments performed in a hospital are generally a hospital service and should be denied as such.
   
   
3. Payment may not be made to a supplier for IPPB treatments. These claims should be denied as services by a non-physician or supplier.

Diathermy (97024) and ultrasound (97035) heat treatments for asthma, bronchitis or other pulmonary conditions are not covered. These services should be denied as not medically necessary. A participating, preferred, or network provider cannot bill the member for the denied service.

Postural Drainage and Pulmonary Exercises

These services are covered as an outpatient therapy service for acute or severe pulmonary conditions, when requested by the attending physician and performed by a physical therapist or inhalation therapist as incident to a doctor's professional service.

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.

Physical therapy is covered when provided by a physician or a licensed physical therapist.

PRN References

10/2003, Pressurized and non-pressurized inhalation therapy now eligible