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TRICARE Policy Manual 6010.60-M, April 1, 2015
Medicine
Chapter 7
Section 13.1
Pulmonary Services
Issue Date:  April 19, 1983
Copyright:  CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Revision:  C-137, December 5, 2024
1.0  CPT PROCEDURE Codes
94002 - 94004, 94010 - 94799
2.0  DESCRIPTION
Services provided for the diagnosis or treatment of conditions involving the lungs.
3.0  POLICY
3.1  Pulmonary services including pulmonary services provided as part of a treatment program on an inpatient or outpatient basis are covered.
3.2  For an indication to be covered the efficacy of the pulmonary services must be proven.
Note:  Examples of proven indications are: cardiopulmonary or pulmonary rehabilitation for pre- and post-lung transplant patients when preauthorized by the appropriate preauthorizing authority as outlined in the Policy on heart-lung and lung transplantation; effective September 13, 1999, severe Chronic Obstructive Pulmonary Disease (COPD) on an inpatient basis; and moderate and severe COPD on an outpatient basis.
3.3  Cryoablation for the treatment of lung malignancies is proven effective July 11, 2023.
4.0  Exclusion
Oscillation and Lung Expansion (OLE) combination devices, such as the Volara system, are unproven for home use.
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