Pulmonary Function Testing (PFT)
Medical necessity guidelines for pulmonary function testing (spirometry, lung volumes, DLCO, exercise testing and related studies) for members aged three years and older under Centene-affiliated health plans.
Added to the medical necessity statement that PFTs are medically necessary for members/enrollees 3 years of age and above.
Multiple ICD-10 codes added to ICD-10 Table 1 and other tables; CPT codes 94617-94619 and 94621 were added as applicable to ICD-10 Table 1.
ICD-10 Table 4 was added to include codes J12.82, J45.990, and Z86.16 supporting medical necessity for CPT codes 94070, 94617, 94618, 94619, and 94621.
Statement that PFTs are medically necessary for members/enrollees 3 years of age and above was added to the medical necessity statement.
CPT code 94150 was added to the CPT code table.
Multiple ICD-10 codes were added to ICD-10 Table 1, and many specific codes were removed from Table 1 and Tables 2–3 across revisions.
Removed demarcation of spirometry indications as diagnostic or for monitoring purposes; noted that indication includes assessing for concurrent restrictive and obstructive disease.
Removed demarcation of spirometry indications as diagnostic versus monitoring and broadened B.2 to include assessing for concurrent restrictive and obstructive disease.
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