Wellmark is adding two new medical policies:
June 1, 2012
Description of Change
Prior approval is recommended for non-emergent air transportation.
Emergent Medical Care Definition
Medically necessary services for an illness or injury that would result in further disability or death if professional attention is not delivered immediately.
Medical Necessary Criteria
- The air ambulance has the necessary patient care equipment and supplies to meet the patient’s needs;
- The patient’s medical condition requires immediate and rapid ambulance transport that could not have been provided by ground ambulance or the point of pick up is inaccessible by land vehicle;
- Great distances, limited time frames, or other obstacles are involved in getting the patient to the nearest hospital with appropriate facilities for treatment;
- The patient’s condition is such that the time needed to transport a patient by land poses a threat to the patient’s health.
Air ambulance service to transport a patient from one facility to another in order to obtain medical treatment that is not available in the facility where they are currently receiving care may be considered medically necessary when the above criteria are met.
Procedure Codes and Billing Guidelines
- HCPCS A0430 – Ambulance service, conventional air services, transport, one way (fixed wing)
- HCPCS A0431 – Ambulance service, conventional air services, transport, one way (rotary wing)
- HCPCS A0435 – Fixed wing air mileage, per statute mile
- HCPCS A0436 – Rotary wing air mileage, per statute mile
- Revenue Code 545
Prior Approval Forms
Exhaled Nitric Oxide and Exhaled Breath Condensate for Asthma and Other Respiratory Disorders
September 1, 2012
Description of Change
Measurement of exhaled nitric oxide or exhaled breath condensate is considered investigational in the diagnosis and management of asthma and other respiratory disorders including but not limited to chronic obstructive pulmonary disease and chronic cough.
The evidence is insufficient to determine the effect of exhaled nitric oxide and exhaled breath condensate tests on health outcomes, and therefore the tests are considered investigational.
Measurements of exhaled nitric oxide and exhaled breath condensate have been investigated in the diagnosis and management of asthma. Potential uses in the management of asthma include assessing response to anti-inflammatory treatment, monitoring compliance with treatment, and predicting exacerbations. They have also been proposed in the management of patients with chronic obstructive pulmonary disease (COPD), cystic fibrosis, allergic rhinitis, and primary ciliary dyskinesia.