Policy Number

Policy Name

Policy Description

Lines of Business

CP.MP.242

Pulmonary Function Testing

Pulmonary function tests (PFTs), also known as lung function tests, include a variety of tests to check how well the lungs are working. This policy describes the medical necessity guidelines for pulmonary function testing.

It is the policy of health plans affiliated with Centene Corporation^® that pulmonary function testing (PFT) is medically necessary for members/enrollees aged three years and above when meeting the criteria for one of the following tests:

· Spirometry

· Lung Volume Tests

· Diffusion capacity of the lungs for Carbon monoxide (DLCO) tests

· Lung compliance studies when all other PFTs give equivocal results or results which must be confirmed by additional lung compliance testing

· Pulmonary studies during exercise testing

Marketplace

CP.MP.97

Testing for Select Genitourinary Conditions

Various diagnostic methods are available to identify the etiology of the signs and symptoms of vaginitis. The purpose of this policy is to define medical necessity criteria for the diagnostic evaluation of vaginitis. This policy also defines unspecified amplified DNA probe testing for genitourinary conditions.

Note: Although Trichomonas vaginalis is a common cause of vaginitis, testing for it is not restricted with medical necessity criteria, and, thus, it is not included in the scope of this policy.

Marketplace

CP.MP.181

Polymerase Chain Reaction Respiratory Viral Panel Testing

Medical necessity criteria for multiplex respiratory polymerase chain reaction (PCR) testing.

Note: For criteria applicable to Medicare plans, please see MC.CP.MP.181 Polymerase Chain Reaction Respiratory Viral Panel Testing.

Marketplace