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-107, January 6, 2023
1.0 CPT PROCEDURE CODES
30000 - 32488, 32491, 32500
- 32999, 64568 - 64570, 64582 - 64584, 96570,
96571, 0467T, 0468T
2.0 HCPCS
Codes
C1767,
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 64582
- 64584) 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 Dates
6.1 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.
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