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Reimbursement Information



Local Coverage Determinations (sorted by carrier)


 

Part B Carrier: Trailblazer Health Enterprises

LCD # Part B Carrier
LCD Title
L26497 Trailblazer Health Enterprises Pulmonary Stress Testing Coverage Indications

 

Part B Carrier: First Coast Service Options

 

LCD # Part B Carrier LCD Title
L29265 First Coast Service Options Pulmonary Diagnostic Services

 

Part B Carrier: Palmetto GBA

LCD # Part B Carrier
LCD Title
L28295 Palmetto GBA Pulmonary Function Testing

 

Medicare provides coverage for items and services for over 43 million beneficiaries. The vast majority of coverage is provided on a local level and developed by clinicians at the contractors that pay Medicare claims. However, in certain cases, Medicare deems it appropriate to develop a National Coverage Determination (NCD) for an item or service to be applied on a national basis for all Medicare beneficiaries meeting the criteria for coverage.


There is no National Coverage Determination for Pulmonary Function Testing.  Below is a partial list of Local Coverage Determinations (LCDs) under the titles Pulmonary Function Testing, Pulmonary Stress Testing, Pulmonary Diagnostic Services, and Respiratory Therapy.  In many cases, Medicare Administrative Contractors will issue LCDs under the same number for different states in their jurisdiction.  If your practice is in one state, but the LCD cites a different state in your same jurisdiction, you may safely assume the same coverage conditions apply to your practice.


If you practice in a Medicare jurisdiction where there is no LCD, you may want to refer to LCDs on this page for coverage guidance.






Coverage and Reimbursement Guide


Shape-HF Reimbursement Summary