Currentpriority healthPolicy BILLING POLICY No. 136
Pulmonary Function Testing
Defines billing, coding and documentation expectations for pulmonary function testing (PFT) for Priority Health members, applying to Commercial, Medicare (per CMS) and Medicaid (per MDHHS) lines of business.
Policy Summary
Payerpriority health
PolicyPulmonary Function Testing
Policy CodePolicy BILLING POLICY No. 136
Change TypeNo material changes
Effective DateAug. 2025
Next Review DateN/A
Key ActionFor indications that do not meet NCD, local LCD or specific medical policy, complete a Pre-Service Organization Determination (PSOD).
SourceLink
POLICY UPDATE CHANGES
No material clinical or coverage changes in this revision.
1policy number
Aug. 2025effective
Commercial/Medicare/Medicaidplan types
Covered CPTscoding guidance
Coverage and Billing Rules
Coverage and billing rules
General billing and documentation expectations and disclaimers about coverage and payment.
Coverage is determined by the member's benefit plan; billing policies outline guidelines to assist providers in accurate claim submissions and define reimbursement or coding requirements.
Providers must maintain industry-standard, complete and thorough documentation to substantiate procedures performed; CPT/HCPCS/revenue codes may be reported only when the service has been performed and fully documented to the highest level of specificity.
Authorization requirements and medical necessity requirements appropriate to procedure, diagnosis and frequency are required; an authorization is not a guarantee of payment and does not supersede coding, billing or reimbursement requirements.
Proper billing and submission guidelines must be followed; failure to document or follow billing/coding requirements may result in claim denial, rejection, or recovery/recoupment of payments.
Policy Summary
Payerpriority health
PolicyPulmonary Function Testing
Policy CodePolicy BILLING POLICY No. 136
Change TypeNo material changes
Effective DateAug. 2025
Next Review DateN/A
Key ActionFor indications that do not meet NCD, local LCD or specific medical policy, complete a Pre-Service Organization Determination (PSOD).
SourceLink
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