G0116
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- Pulmonary rehabilitation (PR) is consideredmedically necessaryin individuals who meet the following criteria:
- Individual is preparing fororrecovering from surgical interventions such as:Lung transplantation;orLung volume reduction surgery;orPost-operative states; (for example, thoracic or abdominal surgery).or
- Lung transplantation;or
- Lung volume reduction surgery;or
- Post-operative states; (for example, thoracic or abdominal surgery).or
- Individual has any of the following conditions:Chronic obstructive pulmonary disease such as:Asthma;orBronchiectasis;orChronic bronchitis;orCystic fibrosis;orEmphysema;orRestrictive diseases such as:Chest wall disease;orInterstitial disease;orPost-polio syndrome;orSelected neuromuscular disorders;orThoracic cage abnormalities;orStable lung cancer;and
1 Active Policy
ANTHEM-CG-REHAB-03 — CG-REHAB-03 Pulmonary Rehabilitation
Related Codes
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