Pulmonary Stress Testing

LCD Information Document Information Source LCD ID N/A LCD ID L33444 Original ICD-9 LCD ID Not Applicable LCD Title Pulmonary Stress Testing Proposed LCD in Comment Period N/A Source Proposed LCD DL33444 Opens in a new window Original Effective Date For services performed on or after 10/01/2015 Revision Effective Date For services performed on or after 01/02/2025 Revision Ending Date N/A Retirement Date N/A Notice Period Start Date 12/22/2016 Notice Period End Date 02/05/2017 CPT codes, descriptions, and other data only are copyright 2025 American Medical Association. All Rights Reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association. Current Dental Terminology © 2025 American Dental Association. All rights reserved. Copyright © 2026, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution, or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at ub04@aha.org or 312‐422‐3366. Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates. Issue Issue Description This LCD outlines limited coverage for this service with specific details under Coverage Indications, Limitations and/or Medical Necessity. Issue - Explanation of Change Between Proposed LCD and Final LCD CMS National Coverage Policy Title XVIII of the Social Security Act §1862(a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.Title XVIII of the Social Security Act §1862(a)(1)(D) indicates no payment can be made for services that are research and/or experimental.Title 42 CFR §410.32(a) indicates that diagnostic tests may be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements). Title 42 CFR §410.32(d)(iii) describes who may furnish covered Medicare Part B diagnostic laboratory tests. CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §231 Pulmonary Rehabilitation (PR) Program Services Effective for Dates of Service on Or After January 1, 2024 CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 4, §240.7 Postural Drainage Procedures and Pulmonary Exercises Coverage Indications, Limitations, and/or Medical Necessity Exercise testing is done to evaluate functional capacity and to assess the severity and type of impairment of existing, as well as undiagnosed conditions. The pulmonary stress test will be considered medically necessary for these conditions:INDICATIONS:Evaluation of exercise tolerance• Determination of functional impairment or capacity • Determination of exercise-limiting factors and pathophysiologic mechanismsEvaluation of undiagnosed exercise intolerance• Assessing contribution of cardiac and pulmonary etiology in coexisting disease• Symptoms disproportionate to resting pulmonary and cardiac tests• Unexplained dyspnea when initial cardiopulmonary testing is nondiagnosticEvaluation of patients with cardiovascular disease• Functional evaluation and prognosis in patients with heart failure• Selection for cardiac transplantation• Exercise prescription and monitoring response to exercise training for cardiac rehabilitation (special circumstances; i.e., pacemakers)Evaluation of patients with respiratory disease• Functional impairment assessment (see specific clinical applications)• Chronic obstructive pulmonary disease: - Establishing exercise limitation(s) and assessing other potential contributing factors, especially occult heart disease (ischemia) - Determination of magnitude of hypoxemia and for O2 prescription - When objective determination of therapeutic intervention is necessary and not adequately addressed by standard pulmonary function testing• Interstitial lung diseases: - Detection of early (occult) gas exchange abnormalities - Overall assessment/monitoring of pulmonary gas exchange - Determination of magnitude of hypoxemia and for O2 prescription - Determination of potential exercise-limiting factors - Documentation of therapeutic response to potentially toxic therapy• Pulmonary vascular disease (careful risk–benefit analysis required)• Cystic fibrosis• Exercise-induced bronchospasmSpecific clinical applications include:1) Preoperative evaluation for:• Surgery involving lung resection• Elderly patients undergoing major abdominal surgery• Lung volume reduction surgery for emphysema2) Clinical decision making:• Exercise evaluation and prescription for pulmonary rehabilitation• Evaluation for impairment–disability• Evaluation for lung, heart–lung transplantationLIMITATIONS:Absolute and relative contraindications to exercise testing (field walking tests) include:Absolute Contraindications• Acute myocardial infarction (3-5 days)• Unstable angina• Uncontrolled arrhythmias causing symptoms or hemodynamic compromise• Syncope• Active endocarditis• Acute myocarditis or pericarditis• Symptomatic severe aortic stenosis• Uncontrolled heart failure• Acute pulmonary embolus or pulmonary infarction• Thrombosis of lower extremities• Suspected dissecting aneurysm• Uncontrolled asthma• Pulmonary edema• SpO2 = 85% on room air• Acute respiratory failure• Acute non-cardiopulmonary disorder that may affect exercise performance or be aggravated by exercise (i.e., infection, renal failure, thyrotoxicosis)• Mental impairment leading to inability to cooperate with the testingRelative Contraindications• Left main coronary artery stenosis or its equivalent• Moderate stenotic valvular heart disease• Severe untreated arterial hypertension at rest (200mmHg systolic, 120mmHg diastolic)• Tachyarrythmias or bradyarrythmias• High degree atrioventricular block• Hypertrophic cardiomyopathy• Significant pulmonary hypertension• Advanced or complicated pregnancies• Electrolyte abnormalities• Orthopedic impairment that prevents walking Summary of Evidence N/A Analysis of Evidence (Rationale for Determination) N/A

Exercise testing is done to evaluate functional capacity and to assess the severity and type of impairment of existing, as well as undiagnosed conditions. The pulmonary stress test will be considered medically necessary for these conditions: INDICATIONS: Evaluation of exercise tolerance • Determination of functional impairment or capacity • Determination of exercise-limiting factors and pathophysiologic mechanisms Evaluation of undiagnosed exercise intolerance • Assessing contribution of cardiac and pulmonary etiology in coexisting disease • Symptoms disproportionate to resting pulmonary and cardiac tests • Unexplained dyspnea when initial cardiopulmonary testing is nondiagnostic Evaluation of patients with cardiovascular disease • Functional evaluation and prognosis in patients with heart failure • Selection for cardiac transplantation • Exercise prescription and monitoring response to exercise training for cardiac rehabilitation (special circumstances; i.e., pacemakers) Evaluation of patients with respiratory disease • Functional impairment assessment (see specific clinical applications) • Chronic obstructive pulmonary disease: - Establishing exercise limitation(s) and assessing other potential contributing factors, especially occult heart disease (ischemia) - Determination of magnitude of hypoxemia and for O2 prescription - When objective determination of therapeutic intervention is necessary and not adequately addressed by standard pulmonary function testing • Interstitial lung diseases: - Detection of early (occult) gas exchange abnormalities - Overall assessment/monitoring of pulmonary gas exchange - Determination of magnitude of hypoxemia and for O2 prescription - Determination of potential exercise-limiting factors - Documentation of therapeutic response to potentially toxic therapy • Pulmonary vascular disease (careful risk–benefit analysis required) • Cystic fibrosis • Exercise-induced bronchospasm Specific clinical applications include: 1) Preoperative evaluation for: • Surgery involving lung resection • Elderly patients undergoing major abdominal surgery • Lung volume reduction surgery for emphysema 2) Clinical decision making: • Exercise evaluation and prescription for pulmonary rehabilitation • Evaluation for impairment–disability • Evaluation for lung, heart–lung transplantation LIMITATIONS: Absolute and relative contraindications to exercise testing (field walking tests) include: Absolute Contraindications • Acute myocardial infarction (3-5 days) • Unstable angina • Uncontrolled arrhythmias causing symptoms or hemodynamic compromise • Syncope • Active endocarditis • Acute myocarditis or pericarditis • Symptomatic severe aortic stenosis • Uncontrolled heart failure • Acute pulmonary embolus or pulmonary infarction • Thrombosis of lower extremities • Suspected dissecting aneurysm • Uncontrolled asthma • Pulmonary edema • SpO2 = 85% on room air • Acute respiratory failure • Acute non-cardiopulmonary disorder that may affect exercise performance or be aggravated by exercise (i.e., infection, renal failure, thyrotoxicosis) • Mental impairment leading to inability to cooperate with the testing Relative Contraindications • Left main coronary artery stenosis or its equivalent • Moderate stenotic valvular heart disease • Severe untreated arterial hypertension at rest (200mmHg systolic, 120mmHg diastolic) • Tachyarrythmias or bradyarrythmias • High degree atrioventricular block • Hypertrophic cardiomyopathy • Significant pulmonary hypertension • Advanced or complicated pregnancies • Electrolyte abnormalities • Orthopedic impairment that prevents walking