Where this LCD applies
Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.
| Contract | Contractor | Type | States |
|---|---|---|---|
| 15102 | CGS Administrators, LLC | MAC - Part B | KY |
| 15202 | CGS Administrators, LLC | MAC - Part B | OH |
| 15101 | CGS Administrators, LLC | MAC - Part A | KY |
| 15201 | CGS Administrators, LLC | MAC - Part A | OH |
Billing and coding: diagnoses and procedure codes
Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A56808 (Billing and Coding: Transtelephonic Spirometry) carries the diagnosis and procedure lists the contractor loads as the claims edit. CPT codes are shown as bare numbers because the descriptors are licensed by the AMA; HCPCS Level II descriptors are public and shown.
A56808: Billing and Coding: Transtelephonic Spirometry (Billing and Coding, effective 2025-10-02)
- Covered ICD-10-CM codes
- 1
- 1 group
- Non-covered ICD-10-CM codes
- 0
- Procedure codes listed
- 3
- Full article
- cms.gov record
| ICD-10-CM | Description (FY2027) |
|---|---|
| Z94.2 | — |
Procedure codes: 94014, 94015, 94016.
Coverage indications, limitations and medical necessity
Spirometry is a non-invasive technique that measures the vital capacity, forced expired volume in one second, and rates airflow at various lung volumes. Measurement of the forced vital capacity and corresponding flow rates is the most commonly used test to detect the presence of lung disease and to monitor changes in severity and response to treatment.
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 physician review and interpretation.
The use of peak flow meters by patients, and their recording and reporting of the results to their physician, has been a standard means of monitoring patients with pulmonary dysfunction at home.
Transtelephonic spirometry has also been investigated in lung heart-lung transplant recipients who underwent monitoring of lung rejection with home spirometry. Scientific conclusions support the utility of home monitoring in this clinical setting. Home spirometry and telespirometry is considered reasonable and medically necessary for lung transplant recipients when the following is met:
1.Lung transplant patient
2. Adherence to home spirometry measurements of ≥80%. This is defined by transmission of data at least 80% of the time.
3. If patient is non-compliant* then they are not eligible for further home spirometry services.
*Non-compliance is defined as no measurements or transmitted for 7 consecutive days x 2. If they are non-compliant for one week the coordinator can reach out and offer education. If non-compliance continues (no measurement for 7 days) then the service will no longer be eligible for coverage.
Home spirometry and telespirometry is considered experimental and investigational for all other indications (asthma, idiopathic pulmonary fibrosis, and persons with other chronic pulmonary diseases/disorders (e.g., emphysema)) because there is a lack of evidence that it will improve the care of persons with these disorders.
Summary of evidence (opening)
A consensus report from the Pulmonary Council of the International Society for Heart and Lung Transplantation (ISHLT) set out to standardize the nomenclature of chronic lung allograft dysfunction (CLAD) and its clinical phenotypes to facilitate collaboration among centers investigating the pathogenesis, prevention, and treatment of CLAD. 1 CLAD is defined as a substantial and persistent decline (≥20%) from baseline in measured FEV1. The baseline value is computed as the mean of the best 2 post-operative FEV1 measurements (taken >3 weeks apart). CLAD can present either as a predominantly obstructive ventilatory pattern, a restrictive pattern, or a mixed obstructive and restrictive pattern that is not explained by other conditions. Consistent pulmonary function testing (PFT) is the leading strategy for early detection of CLAD. While home spirometry devices may provide more variable results, evidence supports it as a useful modality to detect early changes in graft function and may assist providers in decision making.
A systematic review was conducted to determine the effectiveness of home spirometry as a bronchiolitis obliterans syndrome (BOS) detection tool in lung transplant recipients. Eight randomized control trials were included. Authors conclude that home spirometry may be a reliable and safe alternative for lung transplant recipients although they acknowledge the study did not address the impact of early detection on survival outcomes. 2
Finkelstein et al. performed a randomized control trial to determine the relative performance of a computer-based Bayesian triage algorithm compared with a manual nurse-based triage system in terms of patient health and health-related quality of life (QOL) in lung transplant recipients. The trial had 65 lung transplant recipients assigned to either the Bayesian algorithm or nurse triage study arm. Subjects monitored and transmitted spirometry and respiratory symptoms daily to the data center using an electronic spirometer/diary device. Subjects completed the Short Form-36 (SF36) survey at baseline and after 1 year. End points were change from baseline after 1 year in forced expiratory volume at 1 second (FEV1) and quality of life (SF-36 scales) within and between each study arm. A total of 65 subjects (control arm=35, intervention arm=30) yielded an overall adherence of 83% for data collection and 88% adherence during the first year. No significant differences in physical (FEV1) or quality of life (SF-36) measures from baseline after HM triage follow-up for subjects in the two arms, suggesting that subjects’ physiological and functional outcomes were similar regardless of the triage method used to monitor HM data. 3
Fadaizadeh et al. conducted pilot study to evaluate the role of home spirometry in follow up of lung transplant recipients and early detection of complications over a 6-month period. Four subjects were included with 2 of those being matched control subjects. Adherence was 80% and 61% in the active participants. The authors conclude that HS is a viable method for monitoring. 4 The team conducted further investigation with a prospective cohort study on 15 lung transplant recipients to assess patient adherence and satisfaction with telespirometry following lung transplant over 6 months. Study participants were instructed to send home spirometry results and their clinical symptoms via SMS message. Patients’ level of satisfaction showed a sense of increased support from medical staff was rated highest (92.9%) while satisfaction with the spirometer was rated lowest (35.7%). Average patient compliance at baseline was 80% compared to 27% at study completion, resulting in an average of 78% throughout the study duration. Authors conclude telespirometry is an efficient method of monitoring lung transplant recipients with increased patient satisfaction and adherence. 5
The contractor cites 10 sources in the bibliography; the full summary and analysis of evidence are in the CMS record.
Dates, lineage and related policies
- Original determination effective
- 2015-10-01
- Current revision effective
- 2025-10-02
- Last reviewed by the contractor
- 2025-09-25
- MCD version
- 21
- Derived from
- L31907
Other related documents: A59287 (Response to Comments).
Using this policy on a claim
Match the documented indication to the covered indications above before the service is scheduled, carry a diagnosis from the article's covered list on the claim line, and keep the elements the documentation section asks for in the record, because the contractor can request it later through medical review. A denial under this policy arrives as CARC 50 with remark N115; the LCD lookup guide walks through the appeal path and the Advance Beneficiary Notice rules, and the CGS Administrators, LLC hub lists every other active policy from the same contractor.
Frequently asked questions
What does LCD L34541 cover?
Spirometry is a non-invasive technique that measures the vital capacity, forced expired volume in one second, and rates airflow at various lung volumes. Measurement of the forced vital capacity and corresponding flow rates is the most commonly used test to detect the presence of lung disease and to monitor changes in severity and response to treatment. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database export of September 24, 2026.
Which states does LCD L34541 apply to?
CGS Administrators, LLC applies it to Medicare claims in KY, OH. A Local Coverage Determination binds only the contractor that wrote it; the same service in another jurisdiction is judged under that contractor's own policy or, where none exists, claim by claim.
Which diagnosis codes support medical necessity under LCD L34541?
The companion billing and coding article A56808 lists 1 ICD-10-CM codes in 1 group that support medical necessity; the first 1 appear on this page and the complete list is in the article on cms.gov.
How do I appeal a denial under LCD L34541?
The remittance carries claim adjustment reason code 50 with remark code N115, naming the LCD. Compare the documented indication with the policy's covered indications and the article's diagnosis list, then file a redetermination within 120 days with the record attached; if the service genuinely falls outside the policy, the patient can be billed only when a valid Advance Beneficiary Notice was obtained before the service.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file lcd.csvSHA-256 2fcc4251b6ddd1eb…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file article.csvSHA-256 f31932f1df3b4035…
- ICD-10-CM FY2027 code descriptionsVersion FY2027 · effective 2026-10-01 · file icd10cm_codes_2027.txtSHA-256 3c0583a38ee0e848…
Disclaimer
The policy text and code lists are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify against the current LCD and article on cms.gov before billing; coverage depends on the full record and the contractor. Not legal, clinical or billing advice.