Pulmonary Function Testing

This policy covers pulmonary function testing (PFT) — including spirometry, lung volume measurement, and diffusion capacity (DLCO) — as medically necessary to evaluate respiratory symptoms or signs, abnormal laboratory/imaging findings, preoperative risk, monitoring and therapeutic response, and complex conditions such as asthma, COPD, interstitial lung disease, neuromuscular disorders, and transplant evaluation in members/enrollees aged ≥3 years. Major limitations/requirements include an age cutoff excluding children under 3 years, documentation requirements for indications (for example, when post‑bronchodilator spirometry is performed), recent ICD‑10/CPT coding updates, and that the policy is a clinical guide and not a guarantee of payment—coverage is subject to plan terms and applicable laws.

"Pulmonary function testing (PFT) is medically necessary for members/enrollees aged ≥3 years when policy criteria are met."