Respiratory Care

Covers physician-ordered respiratory care and diagnostic/monitoring PFTs (spirometry — with post-bronchodilator testing only when clinically indicated — lung volumes, DLCO), exercise testing (simple/complex), bronchial hygiene, pulmonary rehabilitation, and ventilatory muscle training only for a very select group with markedly decreased respiratory muscle strength who remain symptomatic despite optimal therapy; not covered are routine/non-skilled exercise, generalized group education, routine/repetitive PFTs, and routine testing at every visit. Key requirements: medical necessity documented in the record (clinical indications, clinically significant change for repeat tests), tests ordered by a treating physician or NPP, qualified personnel, individualized education if billed separately, logical sequencing of modalities, and IDTF enrollment/documentation for non‑physician owned diagnostic clinics.

"Spirometry: to detect presence or absence of lung dysfunction suggested by history or clinically significant physical signs and symptoms; detect dysfunction suggested by other abnormal diagnostic t..."