Mountain State Medical Policy Bulletin |
Section: | Diagnostic Medical |
Number: | M-19 |
Topic: | Pulmonary Function Studies |
Effective Date: | January 1, 2009 |
Issued Date: | July 20, 2009 |
Date Last Reviewed: | 12/2008 |
Indications and Limitations of Coverage
Pulmonary Function Studies
Peak Expiratory Flow Rate (PEFR) using a Wright Peak Flow Meter is frequently done as a separate procedure apart from complete spirometry. If reported, payment will be made under procedure code S8110. Claims reporting bronchodilation responsiveness will be processed under procedure code 94060. A complete spirometry is included in this procedure; therefore, if an itemized charge is reported for spirometry when performed in conjunction with bronchodilation responsiveness, the charges will be combined and processed under code 94060. Patient Initiated Spirometry
For asthmatic patients utilizing this service, the medical record must clearly delineate the above criteria. The following codes are used to report patient initiated spirometry:
Patient initiated spirometry performed for all other condidions is considered not medically necessary. Effective January 26, 2009, a participating, preferred, or network provider cannot bill the member for the denied service unless the provider has given advance written notice, informing the member that the service may be deemed not medically necessary and providing an estimate of the cost. The member must agree in writing to assume financial responsibility, in advance of receiving the service. The signed agreement should be maintained in the provider's records.
Description Pulmonary Function Studies Patient Initiated Spirometry |
|
94010 | 94014 | 94015 | 94016 | 94060 | 94150 |
94200 | 94375 | 94799 | A9284 | E0487 | S8110 |
This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits or a contract. Benefits are determined by the Federal Employee Program. |
How Accurate is Spirometry at Predicting Restrictive Pulmonary Impairment?, Chest, Vol. 115, No. 3, March 1999 |
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