The Current Procedural Terminology (CPT) and HCPCS (Healthcare Common Procedure Coding System) codes (based on the American Medical Association’s Current Procedural Terminology – CPT) as defined below are the most common used to describe spirometry and other procedures performed with the Vitalograph spirometers and other devices.
Description
Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation (MVV). Cannot be billed at the same visit as 94060, 94070, or 94728
Vitalograph Devices Applicable: Pneumotrac with Spirotrac V; Pneumotrac with ComPAS; Compact Expert; Alpha Touch; In2itive; Alpha; Micro
Bronchodilation Responsiveness Spirometry as in 94010, pre and post bronchodilator (aerosol) for the purpose of bronchospasm evaluation. This procedure is the same as 94010 with the addition of aerosol treatment delivering a bronchodilator and subsequent repeat of spirometry to measure efficacy of treatment. Post spirometry should be performed at least 5-10 minutes after bronchodilator treatment is completed to give bronchodilator time to reach maximum effectiveness. Cannot be billed at the same visit as 94010, 94070, or 94728
Pneumotrac with Spirotrac V; Pneumotrac with ComPAS; Compact Expert; Alpha Touch; In2itive; Alpha; Micro
Bronchospasm Provocation Evaluation, multiple spirometric determinations as in 94010, with administered agents (e.g. antigen(s), cold air, methacholine) Cannot be billed at the same visit as 94010, 94060, or 94728.
Vitalograph Devices Applicable: Pneumotrac with Spirotrac V; Pneumotrac with ComPAS; Compact Expert; Alpha Touch; In2itive; Alpha; Micro
Spirometry, Home, Patient Recorded with interpretation per 30 days of home measurements. Includes physician interpretation of results. Can be performed with transmission of data to caregiver. Does not require graphic record or full flow/volume detail. PEF & FEV1 are satisfactory for reimbursement. Billed every 30 days.
BT micro and Model 4000 (USB and BT, including asma-1, copd-6, lung monitor)
Remote monitoring of physiologic parameter(s), initial set up and patient education on the use of equipment. Must be ordered by a physician or a Qualified Health Care Professional. Billed once, requires a minimum of 16 days monitoring.
BT micro and Model 4000 (USB and BT, including asma-1, copd-6, lung monitor)
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Monthly remote monitoring of the patient. This includes the supply and use of the medical devices used to remotely monitor and collect patient generated health data. This specifically means data transmission and does not include time spent education and setting up the use of the device.
BT micro and Model 4000 (USB and BT, including asma-1, copd-6, lung monitor)
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Remote physiologic monitoring treatment management services, clinical staff/ physician / or t=other qualified health care professional time in a calendar month requiring interactive communication with the patient / caregiver during the month; first 20 minutes. Performed by physician, other qualified health care professional, or clinical staff under general supervision. Cannot be billed with 99091.
*99458 is for the first 20 minutes and additional 20 min spent by ANY clinical staff including physicians.
BT micro and Model 4000 (USB and BT, including asma-1, copd-6, lung monitor)
Remote physiologic monitoring treatment management services, clinical staff/ physician / other qualified health care professional time in a calendar month requiring interactive communication with the patient / caregiver during the month; additional 20 minutes. Performed by physician, other qualified health care provider or clinical staff under general supervision. Cannot be billed with 99091.
*99458 is for the first 20 minutes and additional 20 min spent by ANY clinical staff including physicians.
BT micro and Model 4000 (USB and BT, including asma-1, copd-6, lung monitor)
Collection and interpretation of physiologic data digitally stored and /or transmitted by the patient and or caregiver to the physician or other qualified healthcare professional, qualified by education, training, licensure / regulation (when applicable) requiring a minimum of 30 minutes of time. Performed by physician or other qualified health care professional, NOT clinical staff. Billed every 30 days. Cannot be billed with 99457 or 99458
BT micro and Model 4000 (USB and BT, including asma-1, copd-6, lung monitor)
*99091 is for the physician or other advance level practitioner time.
A patient’s NO level is measured using specialized equipment and under the direct supervision of a clinician.
Pulmonary function testing by oscillometry. Can not be billed with 94010, 94060, and 94070.
Acknowledgments:
Disclaimer:
The reimbursement information is being provided on an “as is” basis with no express or implied warranty of any kind and should be used solely for your internal informational purposes only. The information does not constitute professional or legal advice on reimbursement and should be used at your sole liability and discretion. All coding, coverage policies and reimbursement information are subject to change without notice. Vitalograph, Inc. does not represent or warrant that any of the information being provided is true or correct and you agree to hold Vitalograph, Inc. harmless in the event of any loss, damage, liabilities or claims arising from the use of the reimbursement information provided to you. Before filing any claims, it is the provider’s sole responsibility to verify current requirements and policies with the applicable payer.
*The material referenced and provided is based upon research current at the time of printing. The final decision of billing for any product or procedure must be made by the provider of care, considering the medical necessity of the services provided, the regulations of insurance carriers and any local, state or federal laws that apply to the services rendered. Vitalograph, Inc. is providing this information in an educational capacity with the understanding that we are not engaged or rendering legal or other professional services or advice. Vitalograph, Inc. does not guaranty Medicare or third-party insurance carrier reimbursement for any of the referenced procedures. Note that applicable laws, rules, and regulations may change. As such, this guide should not be relied upon as a current or comprehensive statement of all applicable laws, rules, and regulations.
**Under Medicare, CPT codes 99453 and 99454 are both practice-expense-only codes. Practice expense is the portion of the resources used in furnishing a service that reflects the general categories of physician and practitioner expenses, such as office rent and personnel wages. There is no physician time or work built into these codes.
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