Pulmonology Coding Alert

Question: Does Medicare establish limits on how many pulmonary function tests (PFTs) we can perform on a patient if we establish medical necessity?

Texas Subscriber

Answer: No, Medicare has no publicly established limits on the number of tests per patient per year. However, CMS has been working on developing limits of PFTs and pulmonary procedures which are practical.

Because different payers might have specific guidelines, check with each carrier to verify if it limits the number of PFTs per year. Whatever the payer's stance might be, always show medical necessity for PFTs or pulmonary procedures your physician completes.