Pulmonary Function Testing Notification

Dear Provider,

Thank you for your continued partnership with Fidelis Care. 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 you of the revision to existing policies Fidelis Care will be implementing effective with Dates of Service starting 8/15/2026. Posted policy on site contains a revision log explaining the updates that occurred in the annual review.

Pulmonary Funtion Testing Policy Information
Policy Number	Policy Name	Policy Descripton	Lines of Business
CP.MP.242	Pulmonary Function Testing	Pulmonary function tests (PFTs), also known as lung function tests, include a variety of tests to check how well the lungs are working. This policy describes the medical necessity guidelines for pulmonary function testing.It is the policy of health plans affiliated with Centene Corporation® that pulmonary function testing (PFT) is medically necessary for members/enrollees aged three years and above when meeting the criteria for one of the following tests: Spirometry Lung Volume Tests Diffusion capacity of the lungs for Carbon monoxide (DLCO) tests Lung compliance studies when all other PFTs give equivocal results or results which must be confirmed by additional lung compliance testing Pulmonary studies during exercise testing	Medicaid Marketplace Commercial

Thank you for your continued participation and cooperation in our ongoing efforts to render quality health care to our members. We look forward to helping you provide the highest quality of care for our members.

Sincerely,
Fidelis Care