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Date Printed: August 21, 2017: 07:25 PM

Private Property of Blue Cross and Blue Shield of Florida.
This medical policy (medical coverage guideline) is Copyright 2017, Blue Cross and Blue Shield of Florida (BCBSF). All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission of BCBSF. The medical codes referenced in this document may be proprietary and owned by others. BCBSF makes no claim of ownership of such codes. Our use of such codes in this document is for explanation and guidance and should not be construed as a license for their use by you. Before utilizing the codes, please be sure that to the extent required, you have secured any appropriate licenses for such use. Current Procedural Terminology (CPT) is copyright 2017 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association. The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

09-E0000-36

Original Effective Date: 12/07/00

Reviewed: 02/22/10

Revised: 11/01/15

Subject: Home Spirometry

THIS MEDICAL COVERAGE GUIDELINE IS NOT AN AUTHORIZATION, CERTIFICATION, EXPLANATION OF BENEFITS, OR A GUARANTEE OF PAYMENT, NOR DOES IT SUBSTITUTE FOR OR CONSTITUTE MEDICAL ADVICE. ALL MEDICAL DECISIONS ARE SOLELY THE RESPONSIBILITY OF THE PATIENT AND PHYSICIAN. BENEFITS ARE DETERMINED BY THE GROUP CONTRACT, MEMBER BENEFIT BOOKLET, AND/OR INDIVIDUAL SUBSCRIBER CERTIFICATE IN EFFECT AT THE TIME SERVICES WERE RENDERED. THIS MEDICAL COVERAGE GUIDELINE APPLIES TO ALL LINES OF BUSINESS UNLESS OTHERWISE NOTED IN THE PROGRAM EXCEPTIONS SECTION.

Position Statement Billing/Coding Reimbursement Program Exceptions Definitions Related Guidelines
Other References Updates

DESCRIPTION:

Home spirometry uses battery-operated spirometers that permit regular daily measurement of pulmonary function in the home, typically forced expiratory volume in 1 second (FEV-1) and forced vital capacity (FVC). The device has been primarily investigated among lung transplant recipients as a technique to provide early diagnosis of infection and rejection. Home spirometry may also be referred to as ambulatory spirometry. Home spirometers should not be confused with incentive spirometers or peak flow meters.

Home spirometry devices allow for the monitoring of pulmonary function in the home. Their primary proposed use is by lung transplant recipients to aid in the early diagnosis of infection and rejection. They can potentially also be used in other situations that require pulmonary function monitoring.

In the immediate post-operative period, lung transplant recipients must be carefully monitored for the development of either rejection episodes or infectious complications. Monitoring techniques include complete pulmonary function testing, serial chest x-rays, bronchioalveolar lavage, and transbronchial biopsy. Transbronchial biopsy is thought to be the only objective method of distinguishing between these 2 common complications. Transbronchial biopsy is typically performed on a routine schedule, with additional biopsies performed if the patient becomes symptomatic. Home spirometry is proposed as a technique to provide daily monitoring to promptly identify presymptomatic patients who may benefit from a diagnostic transbronchial biopsy.

POSITION STATEMENT:

Home spirometry is considered experimental or investigational, as there is insufficient published clinical data to permit scientific conclusions regarding the clinical use of home monitoring of FEV-1 and FVC. There is insufficient clinical evidence that home spirometry improves health outcomes.

NOTE: Home spirometry used for monitoring post-lung and post-lung/heart transplantation recipients is included in the global case rates for the transplantation.

BILLING/CODING INFORMATION:

CPT Coding

94014

Patient-initiated spirometric recording per 30-day period of time; includes reinforced education, transmission of spirometric tracing, data capture, analysis of transmitted data, periodic recalibration and review and interpretation by a physician or other qualified health care professional (investigational)

94015

Patient initiated spirometric recording per 30 day period of time; recording (includes hook-up, reinforced education, data transmission, data capture, trend analysis, and periodic recalibration) (investigational)

94016

Patient-initiated spirometric recording per 30-day period of time; review and interpretation only by a physician or other qualified health care professional (investigational)

NOTE: CPT code 94014 represents the global service, while CPT codes 94015 and 94016 separately represent the recording and physician review and interpretation, respectively. CPT codes 94015 and 94016 would be used, for example, if a monitoring service provided the recording, while a separate physician was responsible for the review and interpretation of the recorded data.

HCPCS Coding

A9284

Spirometer, non-electronic, includes all accessories (investigational)

E0487

Spirometer, electronic, includes all accessories (investigational)

REIMBURSEMENT INFORMATION:

Refer to section entitled POSITION STATEMENT.

PROGRAM EXCEPTIONS:

Federal Employee Program (FEP): Follow FEP guidelines.

State Account Organization (SAO): Follow SAO guidelines.

Medicare Advantage products:

The following Local Coverage Determination (LCD) was reviewed on the last guideline reviewed date: Non-Covered Services (L29288) located at fcso.com.

DEFINITIONS:

Incentive spirometer: device used in pulmonary function testing for measuring the volume of gas moving in and out of the lungs.

Peak flow meter: portable device that measures air flow or peak expiratory flow rate (PEFR); routinely used in the management of asthma for determining airway status.

Spirometry: the measurement of the lungs’ air capacity by a machine called a spirometer. This machine measures and records the amount of air inhaled and exhaled as a patient breathes into a tube connected to the machine.

RELATED GUIDELINES:

None applicable.

OTHER:

Other indexing terms:
Ambulatory spirometry

REFERENCES:

  1. Adam TJ, Finkelstein SM, Parente ST, Hertz MI. Cost analysis of home monitoring in lung transplant recipients. Int J Technol Assess Health Care. 2007 Spring;23(2):216-22. (abstract)
  2. American Association for Respiratory Care (AARC) clinical practice guideline. Spirometry. 1996 Update. Accessed 09/29/09 at AARC Website.
  3. American Lung Association. Spirometry and Other Lung Function Tests Fact Sheet. Accessed 09/29/09 at Website.
  4. American Thoracic Society. Standardization of Spirometry. 1994. Accessed 09/29/09 at ATS Website.
  5. Blue Cross Blue Shield Association Medical Policy 2.01.33 – Home Spirometry (02/11/10).
  6. Dew MA, Dimartini AF, De Vito Dabbs A, Zomak R, De Geest S, Dobbels F, Myaskovsky L, Switzer GE, Unruh M, Steel JL, Kormos RL, McCurry KR. Adherence to the medical regimen during the first two years after lung transplantation. Transplantation. 2008 Jan 27;85(2):193-202. (abstract)
  7. Finkelstein SM, Scudiero A, Lindgren B, Snyder M, Hertz MI. “Decision support for the triage of lung transplant recipients on the basis of home-monitoring spirometry and symptom reporting.” Heart Lung. 2005 May-Jun; 34(3): 201-8.
  8. Finkelstein, Stanley M, MD, et al. Clinical Investigations, “Staging of Bronchiolitis Obliterans Syndrome Using Home Spirometry”. Chest 1999; Vol 116 (07/99).
  9. First Coast Service Options (FCSO), Local Coverage Determination (LCD) for The List of Medicare, Non-Covered Services (L29288), (08/11/09).
  10. Fuehner T., et al. Indicators for steroid response in biopsy proven acute graft rejection after lung transplantation. Respiratory Medicine (2009) 103,1114-1121.
  11. Kugler C, Fuehner T, Dierich M, DeWall C, Haverich A, Simon A, Welte T, Gottlieb J. Effect of adherence to home spirometry on bronchiolitis obliterans and graft survival after lung transplantation. Heart Lung. Transplantation 2009 Jul 15;88(1):129-34. (abstract)
  12. Levine, Stephanie M, MD. “Can Bronchiolitis Obliterans Syndrome Be Diagnosed By Phone From The Comfort of Home?” Chest 1999; Vol 116 (07/99).
  13. Pangarakis SJ, Harrington K, Lindquist R, Peden-McAlpine C, Finkelstein S. Electronic feedback messages for home spirometry lung transplant recipients. Heart Lung. 2008 Jul-Aug;37(4):299-307.
  14. Pelkonen AS, Nikander K, Turpeinen M. “Reproducibility of home spirometry in children with newly diagnosed asthma.” Pediatr Pulmonol. 2000 Jan; 29(1): 34-8.
  15. Wensley D, Silverman M. “Peak flow monitoring for guided self-management in childhood asthma: a randomized controlled trial.” Am J Respir Crit Care Med. 2004 Sep 15; 170(6): 606-12. Epub 2004 Jun 7.
  16. Wensley DC, Silverman M. “The quality of home spirometry in school children with asthma.” Thorax. 2001 Mar; 56(3): 183-5.

COMMITTEE APPROVAL:

This Medical Coverage Guideline (MCG) was approved by the BCBSF Medical Policy & Coverage Committee on 02/22/10.

GUIDELINE UPDATE INFORMATION:

12/07/00

New Medical Coverage Guideline.

01/01/01

Reviewed – no changes.

12/15/02

Reviewed and revised.

11/15/03

Reviewed; no change (investigational).

10/15/04

Scheduled review; no change in coverage statement.

11/15/05

Scheduled review; no change in coverage statement; references updated.

11/15/06

Scheduled review; no change in coverage statement; added S8190.

08/15/07

Scheduled review; reformatted guideline; updated references.

11/15/08

Scheduled review; no change in position statement; add S8190 to the guideline; updated references.

01/01/09

Annual HCPCS coding update: added A9284 and E0487.

04/01/09

HCPCS 1st quarter coding update: remove S8190 – discontinued effective 03/31/09.

11/15/09

Scheduled review; position statement unchanged; references updated.

03/15/10

Revision of Position Statement regarding the use of home spirometry with lung and lung/heart transplant recipients; Description section revised; references updated.

01/01/13

Annual HCPCS coding update: revised descriptors for 94014 and 94016

05/11/14

Revision: Program Exceptions section updated.

11/01/15

Revision: ICD-9 Codes deleted.

Date Printed: August 21, 2017: 07:25 PM