Pulmonology reimbursement alerts

Jascayd (nerandomilast) is an oral tablet approved as a new molecular entity under NDA218764, placing it squarely on the Part D billing pathway for Medicare outpatient prescription coverage. As an orp

Winrevair (sotatercept-csrk) is an injectable drug approved for pulmonary arterial hypertension, administered via injection and billed under Medicare Part B. As a physician-administered injectable bio

Xolair (omalizumab) is a subcutaneously administered anti-IgE monoclonal antibody approved for allergic asthma, with a confirmed Part B billing pathway. As a subcutaneous injection administered in a c

Adempas (riociguat) is an oral tablet approved for pulmonary hypertension indications and follows a Part D billing pathway, consistent with its oral route of administration. As an orphan drug and new

Orenitram (treprostinil) is an oral extended-release tablet approved for pulmonary arterial hypertension, billing under Medicare Part D as a self-administered oral medication. As an orphan drug and th

Arikayce (amikacin liposomal inhalation suspension) received FDA approval in September 2018 as an inhaled orphan drug for refractory Mycobacterium avium complex (MAC) lung disease, administered via a

The finalized LCD L39711 pertains to the use of molecular biomarkers for risk stratification of indeterminate pulmonary nodules following bronchoscopy. This LCD is active and will be effective startin

The final LCD L39658 addresses the use of molecular biomarkers for risk stratification of indeterminate pulmonary nodules following bronchoscopy, effective from June 18, 2026. Healthcare providers in

Provocholine (Methacholine Chloride) is an injectable drug likely to receive a specific J-code for billing. As a Part B candidate, it may be eligible for pass-through payment or reimbursed at ASP+6%.

The proposed Local Coverage Determination (LCD) for nebulizers may impact billing practices by clarifying coverage guidelines for these devices. This could lead to changes in reimbursement rates or el

The implementation of the LCD for Transtelephonic Spirometry will ensure that relevant billing practices align with the latest guidelines. This requires billing team review

The new LCD for Respiratory Care by Noridian is set to take effect on 10/16/2025. This could impact billing processes for related services, requiring providers to stay updated on the specific codes an

The new Local Coverage Determination (LCD) for Respiratory Care by Noridian may impact reimbursement rates and coding requirements for respiratory-related services. Providers should ensure compliance

The upcoming LCD on Hypoglossal Nerve Stimulation for treating obstructive sleep apnea will impact billing by establishing clear guidelines and reimbursement rates for this therapy. Providers should p

The introduction of the Envisia™ test for Idiopathic Pulmonary Fibrosis could enhance diagnostic accuracy and potentially increase testing frequency, impacting overall billing. This could lead to a ri

The introduction of MolDX for stratifying pulmonary nodules may significantly impact billing practices by necessitating new documentation and coding for marker tests. Facilities will need to ensure co

The implementation of MolDX for molecular biomarkers in risk stratification will likely supports compliance with updated rates for procedures related to pulmonary nodules by ensuring proper reimbursement for molecular testi

The update to the MolDX policy for Envisia™ and Veracyte™ tests will enable more accurate billing for idiopathic pulmonary fibrosis diagnostic services. This will likely supports compliance with updated rates fo

This Local Coverage Determination (LCD) addresses the Envisia™ and Veracyte™ diagnostic tests for Idiopathic Pulmonary Fibrosis (IPF). It impacts billing for these specific tests under Medicare, sugge