Notification



Notification Issue Date:



Medicare Advantage Policy

Title:Pulmonary Function Tests
Policy #:MA07.007g

This policy is applicable to the Company’s Medicare Advantage products only. Policies that are applicable to the Company’s commercial products are accessible via a separate commercial policy database.


The Company makes decisions on coverage based on the Centers for Medicare and Medicaid Services (CMS) regulations and guidance, benefit plan documents and contracts, and the member’s medical history and condition. If CMS does not have a position addressing a service, the Company makes decisions based on Company Policy Bulletins. Benefits may vary based on contract, and individual member benefits must be verified. The Company determines medical necessity only if the benefit exists and no contract exclusions are applicable. Although the Medicare Advantage Policy Bulletin is consistent with Medicare’s regulations and guidance, the Company’s payment methodology may differ from Medicare.

When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.


This Policy Bulletin document describes the status of CMS coverage, medical terminology, and/or benefit plan documents and contracts at the time the document was developed. This Policy Bulletin will be reviewed regularly and be updated as Medicare changes their regulations and guidance, scientific and medical literature becomes available, and/or the benefit plan documents and/or contracts are changed.



Policy

Coverage is subject to the terms, conditions, and limitations of the member's Evidence of Coverage.

MEDICALLY NECESSARY

SPIROMETRY
Diagnostic

Spirometry used for diagnostic purposes is considered medically necessary and, therefore, covered when used for any of the following:
  • To evaluate signs, symptoms, or abnormal laboratory tests or radiology studies:
    • Signs: unexplained decreased breath sounds, overinflation, cyanosis, chest deformity, wheezing, or unexplained adventitious sounds
    • Symptoms: unexplained dyspnea, wheezing, orthopnea, cough, or phlegm production
    • Abnormal laboratory tests or radiology studies: (e.g., hypoxemia, hypercapnia, polycythemia, or abnormal chest radiographs)
  • To measure the effect of systemic disease on pulmonary function (e.g., neuromuscular disease and connective tissue disease)
  • To assess an individual's preoperative risk
  • To assess prognosis (e.g., lung transplant, etc.)

Monitoring

Spirometry used for monitoring purposes is considered medically necessary and, therefore, covered when used for either of the following:
  • To assess therapeutic intervention for any of the following:
    • Bronchodilator therapy (see below)
    • Steroid treatment for asthma, interstitial lung disease, etc.
    • Other: (e.g., the use of intravenous antibiotics in the treatment of cystic fibrosis, the management of idiopathic pulmonary fibrosis and chest wall deformities)
  • To monitor for adverse reactions to drugs with known pulmonary toxicity

Spirometry Following Bronchodilator Therapy

Post-bronchodilator spirometry is used to rule out a reversible component to an individual's bronchospasm and to determine if the individual is a candidate for bronchodilator therapy. Therefore, spirometry used for bronchodilator responsiveness (94060) will be considered medically necessary and, therefore, covered for any of the following indications:
  • Individual has signs and/or symptoms consistent with a bronchospasm.
  • Spirometry performed, without the use of a bronchodilator, is abnormal.
  • Reversibility of bronchospasm in response to bronchodilator therapy has not yet been demonstrated.

If reversibility of a bronchospasm (bronchodilator responsiveness) has already been either ruled out or demonstrated, a repeat pre- and post-bronchodilator spirometry to evaluate responsiveness (94060) will be considered medically necessary and, therefore, covered when there is a significant clinical change in the individual's functional respiratory status necessitating an adjustment or augmentation of broncho-active medications.

INDIRECT CALORIMETRY CALCULATIONS
Exhaled air analysis (94690) is used in calorimetry calculation. Indirect calorimetry is used to measure the resting energy expenditure of individuals with morbid obesity to establish their minimum energy requirements.

Exhaled air analysis, when billed with a diagnosis of morbid obesity (E66.01), will be considered medically necessary and, therefore, covered once every two years.

LUNG VOLUMES AND CAPACITIES
The measurement of absolute lung volumes or capacities (i.e., total lung capacity (TLC), residual volume (RV), and functional residual capacity [FRC]) is considered medically necessary and, therefore, covered for any of the following:
  • When the vital capacity (VC) is reduced
  • To distinguish restrictive disease from chronic obstructive pulmonary disease (COPD)
  • For the evaluation of bullous diseases and to explain the data from other lung functions
  • For the assessment of therapeutic interventions, such as a lobectomy and chemotherapy

LUNG DIFFUSION CAPACITY (DLCO)
Diffusion capacity (DLCO) measurement is considered medically necessary and, therefore, covered when spirometry and lung volume studies reveal restrictive disease.

LUNG COMPLIANCE
Lung compliance studies are considered medically necessary and, therefore, covered, when all other pulmonary function tests (PFTs) give equivocal results or the results require confirmation by additional data.

NOT MEDICALLY NECESSARY

All other uses for pulmonary function tests, including for screening purposes, are considered not medically necessary and, therefore, not covered.

NOT ELIGIBLE FOR SEPARATE REIMBURSEMENT

Vital capacity, total (separate procedure) (94150) is always considered to be included in the reimbursement for other services and, therefore, is not eligible for separate reimbursement, whether billed alone or in conjunction with other services.

NOT COVERED

Physician review of a patient-recorded spirometry (94014, 94015 and 94016) is not covered by the Company because it is a service not covered by Medicare. Therefore, this service is not eligible for reimbursement consideration.

REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.
Policy Guidelines

This policy is consistent with Medicare’s coverage determination for pulmonary function tests. The Company’s payment methodology may differ from Medicare.

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable Evidence of Coverage, pulmonary function tests are covered under the medical benefits of the Company’s Medicare Advantage products when the medical necessity criteria listed in this medical policy are met.

However, services that are identified in this policy as not medically necessary or not covered are not eligible for coverage or reimbursement by the Company.

Description

Pulmonary function tests (PFTs) are a group of tests that measure how well the lungs take in and release air and how well the lungs move gases such as oxygen from the atmosphere into the body's circulation.

SPIROMETRY

Spirometry, the most commonly used type of PFTs, is the measurement of airflow via an instrument called a spirometer. By measuring how much air is exhaled, and how quickly, spirometry can evaluate a broad range of lung diseases.

The evaluation of lung function can be used to determine any of the following indications:
  • Presence of lung disease or abnormality of lung function
  • Extent of abnormalities and the potential causative disease process
  • Extent of disability due to abnormal lung function
  • Progression of the disease
  • Type of disease or lesion
  • Response to a course of therapy in the treatment of the particular condition
  • Presence of lung disease or abnormality of lung function secondary to toxicity of medication

Post-bronchodilator spirometry is used to rule out a reversible component to an individual's bronchospasm and determine if the individual is a candidate for bronchodilator therapy.

INDIRECT CALORIMETRY CALCULATIONS

Indirect calorimetry calculations are used to calculate an individual's energy expenditure.

LUNG VOLUMES AND CAPACITIES

Lung volumes (i.e., total lung capacity [TLC], residual volume [RV], and functional residual capacity [FRC]) are used when vital capacity is reduced. The test measures how much air is present in the lungs when a deep breath is taken and how much air remains in the lungs after breathing out fully. Lung volume measurement can help diagnose pulmonary fibrosis or a stiff or weak chest wall.

LUNG DIFFUSION CAPACITY

Diffusion capacity (DLCO) measurement is used to help distinguish between an intrinsic pulmonary process, such as interstitial lung disease and emphysema, and an extrapulmonary process, such as chest wall and neuromuscular disorders. This test measures how well oxygen passes from the lungs to the bloodstream.

LUNG COMPLIANCE

Lung compliance measures the elastic recoil or stiffness of the lungs. It is more invasive than other PFTs because the individual is required to swallow an esophageal balloon.
References

Novitas Solutions, Inc. Local Coverage Article (LCA) A57320 - Billing and Coding: Pulmonary Function Testing. [Novitas Solutions website]. Original 10/01/2019. (Revised 01/01/2020). Available at: https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=57320&ver=12&Keyword=pulmonary+function&KeywordSearchType=Or&Date=&PolicyType=Both&ArticleType=BC%7cSAD%7cRTC%7cReg&Cntrctr=323*1&KeyWordLookUp=Doc&SearchType=Advanced&CoverageSelection=Both&kq=true&bc=IAAAABAAAAAA&. Accessed January 24, 2020.

Novitas Solutions, Inc. Local Coverage Determination (LCD) L35360 - Pulmonary Function Testing. [Novitas Solutions website]. Original 10/01/2015. (Revised 10/17/2019). Available at: https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35360&ver=42&Keyword=pulmonary+function&KeywordSearchType=Or&Date=&PolicyType=Both&ArticleType=SAD%7cEd&Cntrctr=323*1&KeyWordLookUp=Doc&SearchType=Advanced&CoverageSelection=Both&kq=true&bc=IAAAACAAAAAA&. Accessed January 24, 2020.

Ranu H, Wilde M, Madden B. Pulmonary function tests. Ulster Med J. 2011;80(2):84-90. Abstract Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3229853/. Accessed January 24, 2020.



Coding

Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

MEDICALLY NECESSARY

94010, 94011, 94012, 94013, 94060, 94070, 94200, 94250, 94375, 94400, 94450, 94680, 94681, 94690, 94726, 94727, 94728, 94729, 94750, 94770

NOT COVERED
94014, 94015, 94016

NOT ELIGIBLE FOR SEPARATE REIMBURSEMENT
94150



Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD - 10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD -10 Diagnosis Code Number(s)

See Attachment A


HCPCS Level II Code Number(s)

N/A


Revenue Code Number(s)

N/A

Coding and Billing Requirements


Cross References




Policy History

MA07.007g
03/11/2020The policy has been reviewed and reissued to communicate the Company’s continuing position on Pulmonary Function Tests.
01/01/2020This policy has been identified for the CPT code update, effective 01/01/2020.

The following CPT code narrative has been revised in this policy:

94728

MA07.007f
10/01/2019This policy has been identified for the ICD-10 CM code update, effective 10/01/2019.

The following ICD-10 codes have been added to Attachment A in this policy:
  • I26.93 Single subsegmental pulmonary embolism without acute cor pulmonale
  • I26.94 Multiple subsegmental pulmonary emboli without acute cor pulmonale



The following ICD-10 narratives have been revised in Attachment A in this policy:

Changed from:
J44.0 Chronic obstructive pulmonary disease with acute lower respiratory infection

Changed to:
J44.0 Chronic obstructive pulmonary disease with (acute) lower respiratory infection


MA07.007e
02/13/2019The policy has been reviewed and reissued to communicate the Company’s continuing position on Pulmonary Function Tests.
10/01/2018This policy has been identified for the ICD-10 code update, effective 10/01/2018.

The following ICD-10 CM code has been deleted from Att A of this policy:

G71.0 Muscular dystrophy

The following ICD-10 CM codes have been added to Att A of this policy:

G71.00 Muscular dystrophy, unspecified
G71.01 Duchenne or Becker muscular dystrophy
G71.02 Facioscapulohumeral muscular dystrophy
G71.09 Other specified muscular dystrophies

MA07.007d
03/23/2018This version of the policy will become effective 03/23/2018. The intent of this policy remains unchanged; however, the following codes have been added to this policy.

Coding:
The following ICD-10 codes have been added to Attachment A in this policy:

G12.0 Infantile spinal muscular atrophy, type I [Werdnig-Hoffman]
G12.1 Other inherited spinal muscular atrophy
G12.20 Motor neuron disease, unspecified
G12.22 Progressive bulbar palsy
G12.23 Primary lateral sclerosis
G12.24 Familial motor neuron disease
G12.25 Progressive spinal muscle atrophy
G12.29 Other motor neuron disease
G12.8 Other spinal muscular atrophies and related syndromes
G12.9 Spinal muscular atrophy, unspecified

MA07.007c
10/01/2017 This version of the policy will become effective 10/01/2017.
The following ICD-10 codes have been added to Attachment A in this policy.

I27.20 Pulmonary hypertension, unspecified
I27.21 Secondary pulmonary arterial hypertension
I27.22 Pulmonary hypertension due to left heart disease
I27.23 Pulmonary hypertension due to lung diseases and hypoxia
I27.24 Chronic thromboembolic pulmonary hypertension
I27.29 Other secondary pulmonary hypertension
I27.83 Eisenmenger's syndrome
I50.810 Right heart failure, unspecified
I50.811 Acute right heart failure
I50.812 Chronic right heart failure
I50.813 Acute on chronic right heart failure
I50.814 Right heart failure due to left heart failure
I50.82 Biventricular heart failure
I50.83 High output heart failure
I50.84 End stage heart failure
I50.89 Other heart failure
R06.03 Acute respiratory distress

The following ICD-10 CM code has been deleted from Attachment A in this policy:
I27.2

The following ICD-10 narratives have been revised in Attachment A in this policy:

I50.1
FROM: Left ventricular failure
TO: Left ventricular failure, unspecified

M33.01
FROM: Juvenile dermatopolymyositis with respiratory involvement
TO: Juvenile dermatomyositis with respiratory involvement

M33.11
FROM: Other dermatopolymyositis with respiratory involvement
TO: Other dermatomyositis with respiratory involvement

MA07.007b
07/14/2017 The following changes have been made to Attachment A

CPT CODES 94010, 94060, 94200, 94250, 94375, 94400, 94450, 94680, 94681, 94690, 94726, 94727, 94728, 94729, 94750 AND 94770 ARE MEDICALLY NECESSARY WHEN REPORTED WITH THE DIAGNOSIS CODES LISTED IN ATTACHMENT A.

The following diagnosis have been REMOVED:
    B40.9 Blastomycosis, unspecified
    J98.51 Mediastinitis
    Q33.2 Sequestration of lung

The following diagnosis codes have been ADDED
    T53.4X2A Toxic effect of dichloromethane, intentional self-harm, initial encounter
    T53.4X2D Toxic effect of dichloromethane, intentional self-harm, subsequent encounter
    T53.4X2S Toxic effect of dichloromethane, intentional self-harm, sequela
    T53.4X3A Toxic effect of dichloromethane, assault, initial encounter
    T53.4X3D Toxic effect of dichloromethane, assault, subsequent encounter
    T53.4X3S Toxic effect of dichloromethane, assault, sequela
    T53.4X4A Toxic effect of dichloromethane, undetermined, initial encounter
    T53.4X4D Toxic effect of dichloromethane, undetermined, subsequent encounter
    T53.4X4S Toxic effect of dichloromethane, undetermined, sequela

MA07.007a
10/01/2016 This version of the policy will become effective 10/01/2016.

In accordance with Medicare, the following changes were incorporated:
  • The following ICD-10 CM codes have been added into this policy under the following sections:

CPT CODES 94010, 94060, 94200, 94250, 94375, 94400, 94450, 94680, 94681, 94690, 94726, 94727, 94728, 94729, 94750 AND 94770 ARE MEDICALLY NECESSARY WHEN REPORTED WITH THE FOLLOWING DIAGNOSIS CODES:

A15.7, B38.1, B46.0, B46.4, B47.1, B58.3, B59, B67.1, B77.81, B90.9, B95.3, B96.0, C46.50, C46.51, C46.52, C7A.090, C7A.091, C78.1, C78.2, C78.39, C81.92, C82.02, C82.12, C82.22, C82.32, C82.42, C82.52, C82.62, C82.82, C82.92, C83.02, C83.12, C83.32, C83.52, C83.82, C83.92, C84.02, C84.12, C84.42, C84.62, C84.72, C84.A2, C84.Z2, C85.12, C85.22, C85.82, C85.92, C88.0, D14.2, D15.0, D38.2, D38.3, D38.4, D38.5, E66.2, G65.0, G82.50, G82.51, G82.52, G82.53, G82.54, I34.0, I34.2, I35.0, I35.1, J41.8, J68.0, J68.1, J68.2, J68.3, J68.4 J68.8, J68.9, J69.0, J69.1, J69.8, J80, J81.0, J81.1, J82, J84.01, J84.02, J84.03, J85.0, J85.1, J85.2, J85.3, J86.0, J95.02, J95.1, J95.2, J95.3, J95.4, J95.5, J98.2, J98.3, J98.51, J98.59, M06.1, M06.39, M08.1, M30.0, M30.1, M31.1, M31.2, M31.30, M31.31, M31.8, M31.9, M32.13, M33.01 M33.11, M33.21 M33.91, M34.9 M35.00, M35.02, M35.1, M35.8, M36.0, M40.292, M40.293, M40.294, M40.295, M40.30, M40.35, M40.45, M41.34,M41.35, M45.0, M45.2, M45.3, M45.4, M45.5, Q22.1, Q22.2, Q22.3, Q25.71, Q25.72, Q25.79, Q32.0, Q32.1, Q32.2, Q32.3, Q32.4, Q33.0, Q33.1, Q33.2 Q33.3, Q33.4, Q33.5, Q33.6, Q33.8, Q33.9, Q34.0, Q34.1, Q34.8, Q67.8, Q76.412, Q76.413, Q76.414, Q76.415, Q76.8, Q76.9, R94.2, T50.0X1A, T50.0X1D, T50.0X1S T50.0X2A, T50.0X2D, T50.0X2S T50.0X3A T50.0X3D T50.0X3S T50.0X4A T50.0X4D T50.0X4S T50.0X5A T50.0X5D T50. T50.1X1A T50.1X1D T50.1X1S T50.1X2A T50.1X2D T50.1X2S T50.1X3A T50.1X3D T50.1X3S T50.1X4A T50.1X4D T50.1X4S T50.1X5A T50.1X5D T50.1X5S T50.2X1A T50.2X1D T50.2X1S T50.2X2A T50.2X2D T50.2X2S T50.2X3A T50.2X3D T50.2X3S T50.2X4A T50.2X4D T50.2X4S T50.2X5A T50.2X5D T50.2X5S T50.3X1A T50.3X1D T50.3X1S T50.3X2A T50.3X2D T50.3X2S T50.3X3A T50.3X3D T50.3X3S T50.3X4A T50.3X4D T50.3X4S T50.3X5A T50.3X5D T50.3X5S T53.0X1A T53.0X1D T53.0X1S T53.0X2A T53.0X2D T53.0X2S T53.0X3A T53.0X3D T53.0X3S T53.0X4A T53.0X4D T53.0X4S T53.1X1A T53.1X1D T53.1X1S T53.1X2A T53.1X2D T53.1X2S T53.1X3A, T53.1X3D T53.1X3S T53.1X4A T53.1X4D T53.1X4S T53.2X1A T53.2X1D T53.2X1S T53.2X2A T53.2X2D T53.2X2S T53.2X3A T53.2X3D T53.2X3S T53.2X4A T53.2X4D T53.2X4S T53.3X1A T53.3X1D T53.3X1S T53.3X2A T53.3X2D T53.3X2S T53.3X3A T53.3X3D T53.3X3S T53.3X4A T53.3X4D T53.3X4S T53.4X1A T53.4X1D T53.4X1S T53.6X1A T53.6X1D T53.6X1S T53.6X2A T53.6X2D T53.6X2S T53.6X3A T53.6X3D T53.6X3S T53.6X4A T53.6X4D T53.6X4S T53.7X1A T53.7X1D T53.7X1S T53.7X2A T53.7X2D T53.7X2S T53.7X3A T53.7X3D T53.7X3S T53.7X4A T53.7X4D T53.7X4S T58.01XA T58.01XD T58.01XS T58.02XA T58.02XD T58.02XS T58.03XA T58.03XD T58.03XS T58.04XA T58.04XD T58.04XS T58.11XA T58.11XD T58.11XS T58.12XA T58.12XD T58.12XS T58.13XA T58.13XD T58.13XS T58.14XA T58.14XD T58.14XS T58.2X1A T58.2X1D T58.2X1S T58.2X2A, T58.2X2D T58.2X2S T58.2X3A T58.2X3D T58.2X3S T58.2X4A T58.2X4D T58.2X4S Z79.51

CPT CODE 94070 IS MEDICALLY NECESSARY WHEN REPORTED WITH THE FOLLOWING DIAGNOSIS CODES:
J44.0 J44.1 J45.21 J45.31 J45.41 R06.1 R06.2

  • The following ICD-10 CM codes have been deleted from this policy:
    B40.3 B40.81 B40.9 B42.1 B42.81 B42.82 B42.9 B45.1, B45.2 B45.3 B45.9 D86.81 D86.83 D86.84 D86.86 E71.39 E71.40 E71.41 E71.42 E71.43 E71.440 E71.448 E80.3 E84.11 E84.9 G47.00 G47.10 G47.20 G47.30 G47.8 G47.9 J84.841 J84.842 J84.843 J84.848 M32.10 M32.11 M32.19 M32.8 M32.9 M40.00 M40.202 M40.203 M40.204 M40.205 M40.209 M41.116 M41.117 M41.119 M41.126 M41.127 M41.129 M41.20 M41.26 M41.27 Q76.426 Q76.427 Q76.428 Q76.429 R06.81 R06.83 T80.0XXA T80.0XXD T80.0XXS T81.718A T81.718D T81.718S T81.72XA T81.72XD T81.72XS T81.82XA T81.82XD T81.82XS T88.6XXA T88.6XXD T88.6XXS T88.7XXA T88.7XXD T88.7XXS Z79.02

In accordance with the ICD-10, 10/01/2016 Code update.
  • The following ICD-10 codes we revised in this policy
    FROM: C81.12 Nodular sclerosis classical Hodgkin lymphoma, intrathoracic lymph nodes
    TO: C81.12 Nodular sclerosis Hodgkin lymphoma, intrathoracic lymph nodes

    FROM: C81.22 Mixed cellularity classical Hodgkin lymphoma, intrathoracic lymph nodes
    TO: C81.22 Mixed cellularity Hodgkin lymphoma, intrathoracic lymph nodes

    FROM: C81.32 Lymphocyte depleted classical Hodgkin lymphoma, intrathoracic lymph nodes
    TO: C81.32 Lymphocyte depleted Hodgkin lymphoma, intrathoracic lymph nodes

    FROM: C81.42 Lymphocyte-rich classical Hodgkin lymphoma, intrathoracic lymph nodes
    TO: C81.42 Lymphocyte-rich Hodgkin lymphoma, intrathoracic lymph nodes

    FROM: C81.72 Other classical Hodgkin lymphoma, intrathoracic lymph nodes
    TO: C81.72 Other Hodgkin lymphoma, intrathoracic lymph nodes

MA07.007
10/13/2015This new policy has been developed to communicate the Medicare Advantage coverage criteria for pulmonary function tests.





Version Effective Date: 01/01/2020
Version Issued Date: 12/30/2019
Version Reissued Date: 03/11/2020