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Blue Cross & Blue Shield of MississippiCommercial · Coverage · Medical Policy · Pulmonology, Allergy & ImmunologyMedium impact

Measurement of Exhaled Nitric Oxide and Exhaled Breath Condensate in the Diagnosis and Management of Respiratory Disorders

Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

Measurement of exhaled nitric oxide is considered investigational in the diagnosis and management of asthma, eosinophilic asthma and other respiratory disorders, including chronic obstructive pulmonary disease and chronic cough. Measurement of exhaled breath condensate is considered investigational in the diagnosis and management of asthma and other respiratory disorders, including chronic obstructive pulmonary disease and chronic cough. For Federal Employee Program members, devices approved for marketing by the FDA may not be considered investigational and may be assessed only on the basis of medical necessity. The 12/02/2025 review made no changes to the policy statements.

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What to do

Action · 4 steps
01Billing team should treat CPT 95012 (nitric oxide expired gas determination) as investigational for asthma and other respiratory disorders covered by this policy, because the policy lists it under Investigational Codes.
02Treat CPT 83987 (pH; exhaled breath condensate), CPT 84999 (unlisted chemistry procedure) and CPT 94799 (unlisted pulmonary service or procedure) as investigational as well, because the policy also lists them under Investigational Codes.
03Investigative is defined as the use of a treatment, procedure, facility, equipment, drug, device or supply not yet recognized as a generally accepted standard of good medical practice for the condition being treated, and therefore is not considered medically necessary.
04For Federal Employee Program members, FDA-approved devices may be assessed only on the basis of medical necessity.

Codes mentioned

83987849999479995012

Original notice

Measurement of Exhaled Nitric Oxide and Exhaled Breath Condensate in the Diagnosis and Management of Respiratory Disorders
bcbsms.com · Always check the source before changing claims.
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Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesPulmonologyAllergy & ImmunologyCode 83987Code 84999Code 94799Code 95012

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