Mountain State Medical Policy Bulletin |
Section: | Therapy |
Number: | Y-3 |
Topic: | Therapy for Pulmonary Conditions |
Effective Date: | August 1, 2005 |
Issued Date: | April 17, 2006 |
Date Last Reviewed: | 04/2006 |
Indications and Limitations of Coverage
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)
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. |
|
94640 | 94664 | 97024 | 97035 |
Physical therapy is covered when provided by a physician or a licensed physical therapist. |
PRN References |
[Version 001 of Y-3] |