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.
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