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Pulmonary Function Testing: CP.MP.242

Dear Provider,

Thank you for your continued partnership with Centene/WellCare Health Plans of New Jersey. As you know, we continually review and update our payment and utilization policies to ensure that they are designed to comply with industry standards while delivering the best patient experience to our members.

We are writing today to inform providers that there will be a change to the application of the rules governing the provision of Pulmonary Function Testing to Medicaid and NJ FamilyCare beneficiaries. Effective January 1, 2023, payment of Pulmonary Function Testing billed for members over the age of three and medically necessary indications will be limited.

Summary of Policy:

Policy Number

Policy Name

Policy Description

Lines of Business

CP.MP.242

Pulmonary Function Testing

Limits pulmonary function testing to members over the age of three and for medically necessary indications

Medicaid

 

We thank you for your commitment to the care and wellbeing of our members and to the communities we serve. Should you have any questions or concerns about this notification, please contact us at Provider Services (888) 453-2534. Policies are posted on our website at https://www.wellcarenewjersey.com.

Sincerely,

WellCare Health Plans of New Jersey