Program applicability / Prior authorization

This policy applies only to certain programs and products administered by Capital Blue Cross and is subject to benefit variations and program-specific rules. Providers should verify whether the member’s benefit plan is subject to this medical policy before ordering tests or submitting claims. FEP PPO members should refer to the FEP Medical Policy Manual.

• Applicable programs and products may vary — verify member program prior to testing.
• FEP PPO: Refer to FEP Medical Policy Manual (https://www.fepblue.org/benefit-plans/medical-policies-and-utilization-managementguidelines/medical-policies).

Verify coverage / Prior authorization

Prior authorization requirements vary by product and program. Providers should verify coverage and any prior authorization requirements with Capital Blue Cross prior to performing FeNO or exhaled breath condensate testing. Identification of a code in the coding section does not denote coverage.

• Verify benefits and any prior authorization with the member’s plan before testing.
• The presence of a code in the policy’s coding section is not a guarantee of coverage.

Prior authorization requirement

Prior authorization may be required per the member’s benefit program. Administrative or major review notes in the policy do not substitute for program-level prior authorization requirements; check the member’s contract and Capital Blue Cross prior authorization resources.

• Administrative updates and policy revisions do not remove program-level PA requirements.
• Contact Provider Services for plan-specific prior authorization guidance.

Investigational codes — potential denial risk

Use of investigational procedure codes for FeNO or exhaled breath condensate testing may result in claim denials. Coding listed as investigational should be treated as not covered unless otherwise allowed by the member’s benefit terms.

• Investigational / not covered procedure codes include: 83987 and 95012 (Investigational; therefore, not covered).
• Providers submitting these codes should expect potential denials and verify if any program exceptions apply.

Investigational coverage change

Coverage was updated on 02/27/2025: measurement of exhaled nitric oxide is now classified as investigational. Providers should expect claims for FeNO or exhaled breath condensate testing to be subject to denial under this policy effective that revision date unless a specific program or contract allows coverage.

• Policy change date: 02/27/2025 — measurement of exhaled nitric oxide reclassified to investigational.
• Claims for these services after the effective revision may be denied in accordance with this policy.

Claims and documentation

Payment of claims is subject to the member’s benefit terms, eligibility on the date of service, and a determination that the service is medically necessary and appropriate. Claims for investigational services may be denied. Providers must submit documentation that supports medical necessity when requesting prior authorization or submitting claims.

• Claims are processed per the member’s contract, including limitations and exclusions.
• Document clinical rationale, relevant diagnostics, treatment history, and any prior authorization approval to support medical necessity.
• Expect denial for services coded as investigational unless an exception exists in the member’s benefits.

Documentation note

When submitting prior authorization requests or claims, reference policy MP 4.038 and include supporting clinical documentation and references as appropriate. Retain records that demonstrate that guideline-directed asthma management and conventional monitoring were used to guide care.

• Reference: Capital Blue Cross policy MP 4.038 when applicable.
• Include supporting documentation: clinical notes, FEV1/peak flow results, medication trials, blood eosinophils/FeNO results (if obtained), and rationale for testing.
• Document attempts at guideline-directed management prior to investigational testing.

Management of asthma typically relies on

Management of asthma typically relies on guideline-directed therapy and conventional monitoring of respiratory parameters (e.g., FEV1 and peak flow) and long-term suppression of inflammation with inhaled corticosteroids, leukotriene inhibitors, or other anti-inflammatory agents. Noninvasive inflammatory measurements such as FeNO or exhaled breath condensate are considered investigational per this policy and may not alter management unless supported by covered indications or benefit terms.

• Continue standard asthma management: symptom assessment, FEV1, peak flow monitoring, and guideline-directed pharmacologic therapy.
• Consider repeating blood eosinophils and FeNO up to three times in severe asthma scenarios before concluding non–type 2 inflammation (e.g., when asthma worsens, after OCS, or on lowest OCS dose).

Investigational use — provider expectations

Investigational applications of FeNO and exhaled breath condensate testing may be denied. Providers should anticipate possible denials and verify benefit coverage before ordering; appeals should include comprehensive clinical documentation and reference to MP 4.038 and current supporting literature.

• Expect possible denials for investigational use of FeNO/EBC.
• If pursuing an appeal, include detailed clinical documentation and cite MP 4.038 and relevant references.