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Editorial |

Fractional Exhaled Nitric Oxide: Inflamed Coverage Achieves Remission

Scott Manaker, MD, PhD, FCCP
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: Dr Manaker received fees as a grand rounds speaker, lecturer, consultant, and expert witness on documentation, coding, billing, and reimbursement from hospitals, physicians, departments, practice groups, professional societies, insurers, and various attorneys. He received royalties as a Section Editor for UpToDate. Dr Manaker received travel and meal expenses for service on various professional society committees, including the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC); as a Director of CHEST Enterprises, a wholly owned for-profit subsidiary of the American College of Chest Physicians; as an Associate Editor for the journal CHEST; and as a member of the Hospital Outpatient Panel, a federal advisory commission to the Centers for Medicare & Medicaid Services (from 2010 to 2014).

CORRESPONDENCE TO: Scott Manaker, MD, PhD, FCCP, Hospital of the University of Pennsylvania, 100 Centrex, 3400 Spruce St, Philadelphia, PA 19104


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(5):1123-1125. doi:10.1016/j.chest.2015.12.007
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In 2007, the Current Procedural Terminology (CPT) Editorial Panel and Medicare established CPT code 94012 to report fractional exhaled nitric oxide (Feno) measurements. Feno reflects airway inflammation in asthma, as summarized in CHEST shortly thereafter. Both the CPT code approval and subsequent Medicare coverage were predicated on a reasonable evidence base at the time, demonstrating that for people with asthma, Feno test results could alter medical treatment and improve clinically meaningful outcomes. Major professional societies had already established technical standards for the reliable measurement of Feno; so why did it take almost a decade to reach reasonable numbers of annual claims reported to Medicare (Fig 1) and for many other payers to cover this diagnostic test?

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