CPT Codes For Spirometry

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1 Micro Direct, Inc. 803 Webster Street Lewiston, ME (800) (207) FAX CPT Codes For Spirometry The current Procedural Teminology (CPT) codes defined below are the most common used to describe spirometry procedures performed with the Micro Direct spirometers. CPT CODE TEST DESCRIPTION Spirometry Complete, includes graphic record total and timed vital capacity, expiratory flow rate measurement(s) with or without maximal voluntary ventilation National Average $ Bronchodilation Responsiveness, spirometry as in 94010, pre- and post bronchodilator or exercise National Average $ Bronchospasm Provocation Evaluation, multiple spirometric determinations as in 94010, with administered agents (e.g. antigen(s), cold air, methacholine). National Average $ Respiratory Flow Volume Loop National Average $ Inhalation Bronchial Challenge Testing, (not including necessary pulmonary function tests), with histamine, methacholine or similar compounds. National Average $ Bronchodilator Administration, demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, meter dose inhaler or IPPB device. National Average $17.47 Many Medicare Part B carriers have published Local Medical Review Policies (LMRP) that describes specific coverage guidelines for spirometry procedures. For definitive coverage and payment information, contact your local Part B carrier. *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 and supplies provided, the regulations of insurance carriers and any local, state or federal laws that apply to the supplies and services rendered. We are providing this information in an educational capacity with the understanding that we are not engaged or rendering legal, accounting or other professional services or advice. Note that applicable laws, rules and regulations may change. While we will use reasonable efforts to update the guide regularly, this guide should not be relied upon as a current or comprehensive statement of all applicable laws, rules and regulations.

2 Micro Direct, Inc. 803 Webster Street Lewiston, ME (800) (207) FAX ICD-9 Codes For Spirometry Diagnosis ICD-9-CM Codes Smokers over Shortness of Breath Chronic Cough 464.4, Frequent Coughs 460 or 465, 465.0, 465.8, Allergic Rhinitis 506, 506.0, 506.1, 506.2, 506.3, 506.4, Occupational Exposure to Dust or Chemicals 506, 506.0, 506.1, 506.2, 506.3, 506.4, Scoliosis 737, 737.0, 737.1, , 737,12, , 737.2, , , , , 737.3, , , , , , , 737.4, , , , , 737.8, Pigeon Chest 738.3, Barrel Chest Diagnosis of Asthma 493, 493.0, 493.1, 493.2, Diagnosis of Bronchitis 491, 491.0, 491.1, 491.2, 491.8, Diagnosis of other COPD 496 Pre-Operative Evaluation Wheezing High Risk Medication V58.69

3 CPT CODE Spirometry Complete * AK ALASKA AL ALABAMA AR ARKANSAS AZ ARIZONA CA1 MARIN/NAPA/SOLANO, CALIFORNIA CA1 OAKLAND/BERKELEY, CALIFORNIA CA1 REST OF CALIFORNIA CA1 SAN FRANCISCO, CALIFORNIA CA1 SAN MATEO, CALIFORNIA CA1 SANTA CLARA, CA CA2 ANAHEIM/SANTA ANA, CALIFORNIA CA2 LOS ANGELES, CALIFORNIA CA2 REST OF CALIFORNIA CA2 VENTURA, CALIFORNIA CO COLORADO CT CONNECTICUT DC DC + MARYLAND/VIRGINIA SUBURBS DE DELAWARE FL FORT LAUDERDALE, FLORIDA FL MIAMI, FLORIDA FL REST OF FLORIDA GA ATLANTA, GEORGIA GA REST OF GEORGIA HI HAWAII/GUAM IA IOWA ID IDAHO IL CHICAGO, ILLINOIS IL EAST ST. LOUIS, ILLINOIS IL REST OF ILLINOIS IL SUBURBAN CHICAGO, ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY LA NEW ORLEANS, LOUSIANA LA REST OF LOUISIANA MA METROPOLITAN BOSTON, MASSACHUSETTS MA REST OF MASSACHUSETTS MD BALTIMORE/SURROUNDING COUNTIES, MARYLAND MD REST OF MARYLAND ME REST OF MAINE ME SOUTHERN MAINE MI DETROIT, MICHIGAN MI REST OF MICHIGAN MN MINNESOTA MO METROPOLITAN KANSAS CITY, MISSOURI MO METROPOLITAN ST. LOUIS, MISSOURI MO REST OF MISSOURI

4 CPT CODE Spirometry Complete * MS MISSISSIPPI MT MONTANA NC NORTH CAROLINA ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NORTHERN NEW JERSEY NJ REST OF NEW JERSEY NM NEW MEXICO NV NEVADA NY1 REST OF NEW YORK NY2 MANHATTAN, NEW YORK NY2 NYC SUBURBS/LONG ISLAND, NEW YORK NY2 POUGHKEEPSIE/N NYC SUBURBS, NEW YORK NY3 QUEENS, NEW YORK OH OHIO OK OKLAHOMA OR PORTLAND, OR OR REST OF OREGON PA METROPOLITAN PHILADELPHIA, PENNSYLVANIA PA REST OF PENSYLVANIA PRV PUERTO RICO PRV VIRGIN ISLANDS RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX AUSTIN, TEXAS TX BEAUMONT, TEXAS TX BRAZORIA, TEXAS TX DALLAS, TEXAS TX FORT WORTH, TEXAS TX GALVESTON, TEXAS TX HOUSTON, TEXAS TX REST OF TEXAS UT UTAH VA VIRGINIA VT VERMONT WA REST OF WASHINGTON WA SEATTLE (KING COUNTY), WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING *Facility: Includes hospitals (inpatient, outpatient and emergency department), ambulatory surgical centers (ASCs) and skilled nursing facilities (SNFs) **Non Facility: Includes all other settings.

5 CPT Code Bronchodilation Responsiveness * AK ALASKA AL ALABAMA AR ARKANSAS AZ ARIZONA CA1 MARIN/NAPA/SOLANO, CALIFORNIA CA1 OAKLAND/BERKELEY, CALIFORNIA CA1 REST OF CALIFORNIA CA1 SAN FRANCISCO, CALIFORNIA CA1 SAN MATEO, CALIFORNIA CA1 SANTA CLARA, CA CA2 ANAHEIM/SANTA ANA, CALIFORNIA CA2 LOS ANGELES, CALIFORNIA CA2 REST OF CALIFORNIA CA2 VENTURA, CALIFORNIA CO COLORADO CT CONNECTICUT DC DC + MARYLAND/VIRGINIA SUBURBS DE DELAWARE FL FORT LAUDERDALE, FLORIDA FL MIAMI, FLORIDA FL REST OF FLORIDA GA ATLANTA, GEORGIA GA REST OF GEORGIA HI HAWAII/GUAM IA IOWA ID IDAHO IL CHICAGO, ILLINOIS IL EAST ST. LOUIS, ILLINOIS IL REST OF ILLINOIS IL SUBURBAN CHICAGO, ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY LA NEW ORLEANS, LOUSIANA LA REST OF LOUISIANA MA METROPOLITAN BOSTON, MASSACHUSETTS MA REST OF MASSACHUSETTS MD BALTIMORE/SURROUNDING COUNTIES, MARYLAND MD REST OF MARYLAND ME REST OF MAINE ME SOUTHERN MAINE MI DETROIT, MICHIGAN MI REST OF MICHIGAN MN MINNESOTA MO METROPOLITAN KANSAS CITY, MISSOURI MO METROPOLITAN ST. LOUIS, MISSOURI MO REST OF MISSOURI

6 CPT Code Bronchodilation Responsiveness * MS MISSISSIPPI MT MONTANA NC NORTH CAROLINA ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NORTHERN NEW JERSEY NJ REST OF NEW JERSEY NM NEW MEXICO NV NEVADA NY1 REST OF NEW YORK NY2 MANHATTAN, NEW YORK NY2 NYC SUBURBS/LONG ISLAND, NEW YORK NY2 POUGHKEEPSIE/N NYC SUBURBS, NEW YORK NY3 QUEENS, NEW YORK OH OHIO OK OKLAHOMA OR PORTLAND, OR OR REST OF OREGON PA METROPOLITAN PHILADELPHIA, PENNSYLVANIA PA REST OF PENSYLVANIA PRV PUERTO RICO PRV VIRGIN ISLANDS RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX AUSTIN, TEXAS TX BEAUMONT, TEXAS TX BRAZORIA, TEXAS TX DALLAS, TEXAS TX FORT WORTH, TEXAS TX GALVESTON, TEXAS TX HOUSTON, TEXAS TX REST OF TEXAS UT UTAH VA VIRGINIA VT VERMONT WA REST OF WASHINGTON WA SEATTLE (KING COUNTY), WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING *Facility: Includes hospitals (inpatient, outpatient and emergency department), ambulatory surgical centers (ASCs) and skilled nursing facilities (SNFs) **Non Facility: Includes all other settings.

7 CPT Code Bronchospasm Provocation Evaluation * AK ALASKA AL ALABAMA AR ARKANSAS AZ ARIZONA CA1 MARIN/NAPA/SOLANO, CALIFORNIA CA1 OAKLAND/BERKELEY, CALIFORNIA CA1 REST OF CALIFORNIA CA1 SAN FRANCISCO, CALIFORNIA CA1 SAN MATEO, CALIFORNIA CA1 SANTA CLARA, CA CA2 ANAHEIM/SANTA ANA, CALIFORNIA CA2 LOS ANGELES, CALIFORNIA CA2 REST OF CALIFORNIA CA2 VENTURA, CALIFORNIA CO COLORADO CT CONNECTICUT DC DC + MARYLAND/VIRGINIA SUBURBS DE DELAWARE FL FORT LAUDERDALE, FLORIDA FL MIAMI, FLORIDA FL REST OF FLORIDA GA ATLANTA, GEORGIA GA REST OF GEORGIA HI HAWAII/GUAM IA IOWA ID IDAHO IL CHICAGO, ILLINOIS IL EAST ST. LOUIS, ILLINOIS IL REST OF ILLINOIS IL SUBURBAN CHICAGO, ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY LA NEW ORLEANS, LOUSIANA LA REST OF LOUISIANA MA METROPOLITAN BOSTON, MASSACHUSETTS MA REST OF MASSACHUSETTS MD BALTIMORE/SURROUNDING COUNTIES, MARYLAND MD REST OF MARYLAND ME REST OF MAINE ME SOUTHERN MAINE MI DETROIT, MICHIGAN MI REST OF MICHIGAN MN MINNESOTA MO METROPOLITAN KANSAS CITY, MISSOURI MO METROPOLITAN ST. LOUIS, MISSOURI MO REST OF MISSOURI

8 CPT Code Bronchospasm Provocation Evaluation * MS MISSISSIPPI MT MONTANA NC NORTH CAROLINA ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NORTHERN NEW JERSEY NJ REST OF NEW JERSEY NM NEW MEXICO NV NEVADA NY1 REST OF NEW YORK NY2 MANHATTAN, NEW YORK NY2 NYC SUBURBS/LONG ISLAND, NEW YORK NY2 POUGHKEEPSIE/N NYC SUBURBS, NEW YORK NY3 QUEENS, NEW YORK OH OHIO OK OKLAHOMA OR PORTLAND, OR OR REST OF OREGON PA METROPOLITAN PHILADELPHIA, PENNSYLVANIA PA REST OF PENSYLVANIA PRV PUERTO RICO PRV VIRGIN ISLANDS RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX AUSTIN, TEXAS TX BEAUMONT, TEXAS TX BRAZORIA, TEXAS TX DALLAS, TEXAS TX FORT WORTH, TEXAS TX GALVESTON, TEXAS TX HOUSTON, TEXAS TX REST OF TEXAS UT UTAH VA VIRGINIA VT VERMONT WA REST OF WASHINGTON WA SEATTLE (KING COUNTY), WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING *Facility: Includes hospitals (inpatient, outpatient and emergency department), ambulatory surgical centers (ASCs) and skilled nursing facilities (SNFs) **Non Facility: Includes all other settings.

9 CPT Code Respiratory Flow Volume Loop * AK ALASKA AL ALABAMA AR ARKANSAS AZ ARIZONA CA1 MARIN/NAPA/SOLANO, CALIFORNIA CA1 OAKLAND/BERKELEY, CALIFORNIA CA1 REST OF CALIFORNIA CA1 SAN FRANCISCO, CALIFORNIA CA1 SAN MATEO, CALIFORNIA CA1 SANTA CLARA, CA CA2 ANAHEIM/SANTA ANA, CALIFORNIA CA2 LOS ANGELES, CALIFORNIA CA2 REST OF CALIFORNIA CA2 VENTURA, CALIFORNIA CO COLORADO CT CONNECTICUT DC DC + MARYLAND/VIRGINIA SUBURBS DE DELAWARE FL FORT LAUDERDALE, FLORIDA FL MIAMI, FLORIDA FL REST OF FLORIDA GA ATLANTA, GEORGIA GA REST OF GEORGIA HI HAWAII/GUAM IA IOWA ID IDAHO IL CHICAGO, ILLINOIS IL EAST ST. LOUIS, ILLINOIS IL REST OF ILLINOIS IL SUBURBAN CHICAGO, ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY LA NEW ORLEANS, LOUSIANA LA REST OF LOUISIANA MA METROPOLITAN BOSTON, MASSACHUSETTS MA REST OF MASSACHUSETTS MD BALTIMORE/SURROUNDING COUNTIES, MARYLAND MD REST OF MARYLAND ME REST OF MAINE ME SOUTHERN MAINE MI DETROIT, MICHIGAN MI REST OF MICHIGAN MN MINNESOTA MO METROPOLITAN KANSAS CITY, MISSOURI MO METROPOLITAN ST. LOUIS, MISSOURI MO REST OF MISSOURI

10 CPT Code Respiratory Flow Volume Loop * MS MISSISSIPPI MT MONTANA NC NORTH CAROLINA ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NORTHERN NEW JERSEY NJ REST OF NEW JERSEY NM NEW MEXICO NV NEVADA NY1 REST OF NEW YORK NY2 MANHATTAN, NEW YORK NY2 NYC SUBURBS/LONG ISLAND, NEW YORK NY2 POUGHKEEPSIE/N NYC SUBURBS, NEW YORK NY3 QUEENS, NEW YORK OH OHIO OK OKLAHOMA OR PORTLAND, OR OR REST OF OREGON PA METROPOLITAN PHILADELPHIA, PENNSYLVANIA PA REST OF PENSYLVANIA PRV PUERTO RICO PRV VIRGIN ISLANDS RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX AUSTIN, TEXAS TX BEAUMONT, TEXAS TX BRAZORIA, TEXAS TX DALLAS, TEXAS TX FORT WORTH, TEXAS TX GALVESTON, TEXAS TX HOUSTON, TEXAS TX REST OF TEXAS UT UTAH VA VIRGINIA VT VERMONT WA REST OF WASHINGTON WA SEATTLE (KING COUNTY), WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING *Facility: Includes hospitals (inpatient, outpatient and emergency department), ambulatory surgical centers (ASCs) and skilled nursing facilities (SNFs) **Non Facility: Includes all other settings.

11 CPT Code Inhalation Bronchial Challenge Testing * AK ALASKA AL ALABAMA AR ARKANSAS AZ ARIZONA CA1 MARIN/NAPA/SOLANO, CALIFORNIA CA1 OAKLAND/BERKELEY, CALIFORNIA CA1 REST OF CALIFORNIA CA1 SAN FRANCISCO, CALIFORNIA CA1 SAN MATEO, CALIFORNIA CA1 SANTA CLARA, CA CA2 ANAHEIM/SANTA ANA, CALIFORNIA CA2 LOS ANGELES, CALIFORNIA CA2 REST OF CALIFORNIA CA2 VENTURA, CALIFORNIA CO COLORADO CT CONNECTICUT DC DC + MARYLAND/VIRGINIA SUBURBS DE DELAWARE FL FORT LAUDERDALE, FLORIDA FL MIAMI, FLORIDA FL REST OF FLORIDA GA ATLANTA, GEORGIA GA REST OF GEORGIA HI HAWAII/GUAM IA IOWA ID IDAHO IL CHICAGO, ILLINOIS IL EAST ST. LOUIS, ILLINOIS IL REST OF ILLINOIS IL SUBURBAN CHICAGO, ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY LA NEW ORLEANS, LOUSIANA LA REST OF LOUISIANA MA METROPOLITAN BOSTON, MASSACHUSETTS MA REST OF MASSACHUSETTS MD BALTIMORE/SURROUNDING COUNTIES, MARYLAND MD REST OF MARYLAND ME REST OF MAINE ME SOUTHERN MAINE MI DETROIT, MICHIGAN MI REST OF MICHIGAN MN MINNESOTA MO METROPOLITAN KANSAS CITY, MISSOURI MO METROPOLITAN ST. LOUIS, MISSOURI MO REST OF MISSOURI

12 CPT Code Inhalation Bronchial Challenge Testing * MS MISSISSIPPI MT MONTANA NC NORTH CAROLINA ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NORTHERN NEW JERSEY NJ REST OF NEW JERSEY NM NEW MEXICO NV NEVADA NY1 REST OF NEW YORK NY2 MANHATTAN, NEW YORK NY2 NYC SUBURBS/LONG ISLAND, NEW YORK NY2 POUGHKEEPSIE/N NYC SUBURBS, NEW YORK NY3 QUEENS, NEW YORK OH OHIO OK OKLAHOMA OR PORTLAND, OR OR REST OF OREGON PA METROPOLITAN PHILADELPHIA, PENNSYLVANIA PA REST OF PENSYLVANIA PRV PUERTO RICO PRV VIRGIN ISLANDS RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX AUSTIN, TEXAS TX BEAUMONT, TEXAS TX BRAZORIA, TEXAS TX DALLAS, TEXAS TX FORT WORTH, TEXAS TX GALVESTON, TEXAS TX HOUSTON, TEXAS TX REST OF TEXAS UT UTAH VA VIRGINIA VT VERMONT WA REST OF WASHINGTON WA SEATTLE (KING COUNTY), WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING *Facility: Includes hospitals (inpatient, outpatient and emergency department), ambulatory surgical centers (ASCs) and skilled nursing facilities (SNFs) **Non Facility: Includes all other settings.

13 CPT Code Bronchodilator Demonstration/Evaluation * AK ALASKA AL ALABAMA AR ARKANSAS AZ ARIZONA CA1 MARIN/NAPA/SOLANO, CALIFORNIA CA1 OAKLAND/BERKELEY, CALIFORNIA CA1 REST OF CALIFORNIA CA1 SAN FRANCISCO, CALIFORNIA CA1 SAN MATEO, CALIFORNIA CA1 SANTA CLARA, CA CA2 ANAHEIM/SANTA ANA, CALIFORNIA CA2 LOS ANGELES, CALIFORNIA CA2 REST OF CALIFORNIA CA2 VENTURA, CALIFORNIA CO COLORADO CT CONNECTICUT DC DC + MARYLAND/VIRGINIA SUBURBS DE DELAWARE FL FORT LAUDERDALE, FLORIDA FL MIAMI, FLORIDA FL REST OF FLORIDA GA ATLANTA, GEORGIA GA REST OF GEORGIA HI HAWAII/GUAM IA IOWA ID IDAHO IL CHICAGO, ILLINOIS IL EAST ST. LOUIS, ILLINOIS IL REST OF ILLINOIS IL SUBURBAN CHICAGO, ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY LA NEW ORLEANS, LOUSIANA LA REST OF LOUISIANA MA METROPOLITAN BOSTON, MASSACHUSETTS MA REST OF MASSACHUSETTS MD BALTIMORE/SURROUNDING COUNTIES, MARYLAND MD REST OF MARYLAND ME REST OF MAINE ME SOUTHERN MAINE MI DETROIT, MICHIGAN MI REST OF MICHIGAN MN MINNESOTA MO METROPOLITAN KANSAS CITY, MISSOURI MO METROPOLITAN ST. LOUIS, MISSOURI MO REST OF MISSOURI

14 CPT Code Bronchodilator Demonstration/Evaluation * MS MISSISSIPPI MT MONTANA NC NORTH CAROLINA ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NORTHERN NEW JERSEY NJ REST OF NEW JERSEY NM NEW MEXICO NV NEVADA NY1 REST OF NEW YORK NY2 MANHATTAN, NEW YORK NY2 NYC SUBURBS/LONG ISLAND, NEW YORK NY2 POUGHKEEPSIE/N NYC SUBURBS, NEW YORK NY3 QUEENS, NEW YORK OH OHIO OK OKLAHOMA OR PORTLAND, OR OR REST OF OREGON PA METROPOLITAN PHILADELPHIA, PENNSYLVANIA PA REST OF PENSYLVANIA PRV PUERTO RICO PRV VIRGIN ISLANDS RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX AUSTIN, TEXAS TX BEAUMONT, TEXAS TX BRAZORIA, TEXAS TX DALLAS, TEXAS TX FORT WORTH, TEXAS TX GALVESTON, TEXAS TX HOUSTON, TEXAS TX REST OF TEXAS UT UTAH VA VIRGINIA VT VERMONT WA REST OF WASHINGTON WA SEATTLE (KING COUNTY), WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING *Facility: Includes hospitals (inpatient, outpatient and emergency department), ambulatory surgical centers (ASCs) and skilled nursing facilities (SNFs) **Non Facility: Includes all other settings.

Rates are valid through March 31, 2014.

Rates are valid through March 31, 2014. The data in this chart was compiled from the physician fee schedule information posted on the CMS website as of January 2014. CPT codes and descriptions are copyright 2012 American Medical Association.

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