Chapter 4
Section 8.1
Respiratory System
Issue Date: August 26, 1985
Copyright: CPT
only © 2006 American Medical Association (or such other date of
publication of CPT).
All Rights Reserved.
Revision: C-75, November 13, 2020
1.0 CPT
PROCEDURE CODES
30000 - 32488, 32491, 32500
- 32999, 64568 - 64570, 96570, 96571,
0466T - 0468T
2.0
HCPCS CodesC1767, C1778, C1787
3.0 DESCRIPTION
The respiratory
system is comprised of the tubular and cavernous organs and structures
by means of which pulmonary ventilation and gas exchange between
ambient air and the blood are brought about.
4.0 POLICY
4.1 Services
and supplies required in the diagnosis and treatment of illness
or injury involving the respiratory system are covered.
4.2 Resection
of pneumatoceles is a covered procedure.
4.3 Lung Volume
Reduction Surgery (LVRS) is a covered procedure, see
Section 8.2.
4.4 Endoscopic
thoracic sympathectomy (Current Procedural Terminology (CPT) procedure
code 32664) is covered for treatment of severe primary hyperhidrosis
when appropriate nonsurgical therapies have failed and the hyperhidrosis
results in significant functional impairment.
4.5 Implantable Hypoglossal Nerve
Stimulation (HGNS) (CPT 64568 and 0466T) for the treatment of moderate-to-severe
Obstructive Sleep Apnea (OSA) is covered in accordance with U.S.
Food and Drug Administration (FDA) labeled indications.
5.0 Exclusions
5.1 Pillar
palatal implant system for the treatment of OSA
is unproven.
5.2 Uvulopalatopharyngoplasty (UPPP) (CPT procedure
code 42145) for the treatment of Upper Airway Resistance Syndrome
(UARS) is unproven).
5.3 Nitric
oxide expired gas determination (CPT procedure code 95012) for asthma
is unproven.
5.4 Bronchial Thermoplasty (BT) (CPT procedure
codes 31660 and 31661) for the treatment of asthma is unproven.
5.5 Radiofrequency
Ablation (RFA) of the tongue base to treat Obstructive Sleep Apnea
(OSA) is unproven.
6.0 Effective Date
s6.1 December
1, 2006, for endoscopic thoracic sympathectomy for severe primary
hyperhidrosis.
6.2 August
15, 2019, for HGNS for the treatment of moderate-to-severe OSA.
- END -