CPT codes are for information only; consult your payer organization for reimbursement information.

Transcription

1 CPT codes are for information only; consult your payer organization for reimbursement information. Coverage for Spirometry/Oximetry Spirometry is a component of pulmonary function testing (PFTs). PFTs describe several measurements designed to identify and quantify pulmonary impairments. Spirometry specifically measures forced vital capacity (FVC) and other measurements that can be obtained from FVC measurements. Local coverage determinations (LCDs) have been written by many Medicare Part B carriers and, if available, may be obtained by contacting your Medicare Part B payer or by calling the Health Care Economics Department at (800) An example of general coverage indications are for diagnostic or monitoring purposes as described below (Source: Empire (New York) Medicare Pulmonary Function Testing Policy #PU002E03): Diagnostic To evaluate symptoms, signs or abnormal laboratory tests Symptoms: unexplained dyspnea, wheezing, orthopnea, cough, phlegm production Signs: unexplained diminutive breath sounds, overinflation, cyanosis, chest deformity, unexplained crackles Abnormal laboratory tests: hypoxemia, hypercapnia, polycythemia, abnormal chest radiographs To measure the effect of systemic disease on pulmonary function (e.g. neuromuscular disease, connective tissue disease) To assess preoperative risk To assess prognosis (lung transplant, etc.) Monitoring To assess therapeutic interventions: Bronchodilator therapy Steroid treatment for asthma, interstitial lung disease, etc. Other (antibiotics in cystic fibrosis, etc.) To monitor for adverse reactions to drugs with known pulmonary toxicity CPT Codes CPT Code Description Medicare Unadjusted Allowable Limits Spirometry, including graphical record vital capacity, expiratory flow rate $33 per test with or without maximal voluntary ventilation Bronchodilator responsiveness $55 per test pre and post administration

2 94375 Flow Volume Loop $36 per test (cannot be used with or Pulse Oximetry CPT Codes CPT Code Description Non-invasive pulse oximetry for oxygen saturation (single determination) Non-invasive pulse oximetry for oxygen saturation (multiple determination) [e.g. during exercise] Non-invasive pulse oximetry for oxygen saturation by overnight monitoring Medicare Unadjusted Allowable Limits $2.45 per test $5.32 per test $22.33 per test CPT codes 94010, 94060, 94200, 94240, 94375, Low High Description Tuberculosis of lung, infiltrative Tuberculosis of lung, nodular Tuberculosis of lung with cavitation Tuberculosis of bronchus Tuberculous fibrosis of lung Tuberculous bronchiectasis Tuberculous pneumonia (any form) Tuberculous pnuemothorax Other specified pulmonary tuberculosis Pulmonary tuberculosis, unspecified Tuberculous pleurisy Tuberculosis of intrathoracic lymph nodes Isolated thracheal or bronchial tuberculosis Tuberculous laryngitis Other specified respiratory tuberculosis

3 031.0 Diseases due to other mycobacteria, pulmonary Actinomycotic infections; pulmonary Acute paralytic poliomyelitis specified as bulbar SARS-associated coronavirus Primary coccidioidomycosis (pulmonary) Blastomycosis Sporotrichosis Cryptococcosis 135 Saroidosis 138 Late effects of acute poliomyelitis Malignant neoplasm of trachea Malignant neoplasm of main bronchus Malignant neoplasm of upper lobe, bronchus or lung Malignant neoplasm of middle lobe, bronchus or lung Malgnant neoplasm of lower lobe, bronchus or lung Malignant neoplasm of other parts of bronchus or lung Malignant neoplasm of bronchus and lung, unspecified Malignant neoplasm of parietal pleura Malignant neoplasm of visceral pleura Malignant neoplasm of other specified sites of pleura Malignant neoplasm of pleura, unspecified Malignant neoplasm of thymus Malignant neoplasm of heart Malignant neoplasm of anterior mediastinum Malignant neoplasm of posterior mediastinum Other malignant neoplasm Malignant neoplasm of mediastinum, part unspecified Malignant neoplasm of upper repiratory tract, part unspecified Malignant neoplasm of other and ill defined sites within the repiratory system and intrathoracic organs Secondary malignant neoplasm of lung Benign neoplasm of bronchus and lung Benign neoplasm of pleura Benign neoplasm of mediastinum Pulmonary lymphangioma, any site Carcinoma in situ, bronchus and lung

4 235.7 Neoplasm of uncertain behavior, trachea, bronchus, and lung Neoplasm of unspecified nature of the respiratory system Cystic fibrosis; without mention of meconium ileus Cystic fibrosis; with meconium ileus Cystic fibrosis; with pulmonary manifestations Cystic fibrosis; with gastrointestinal manifestations Cystic fibrosis; with other manifestations Primary carnitine deficiency Carnitine deficiency due to inborn errors of metabolism latrogenic carnitine deficiency Other secondary carnitine deficiency Other specified disorders of metabolism Polycythemia, secondary Amyotrophic lateral sclerosis Other specified paralytic syndrome Acute Infective polyneuritis Myastheniagravis without (acute) exacerbation Myastheniagravis with (acute) exacerbation Hereditary progressive muscular dystrophy latrogenic pulmonary embolism and infarction Other pulmonary embolism and infarction Primary pulmonary hypertension Kyphoscoliotic heart disease Other chronic pulmonary heart diseases Chronic pulmonary heart disease, unspecified Congestive heart failure, unspecified Left heart failure Systolic heart failure Diastolic heart failure Combined systolic and diastolic heart failure Heart failure unspecified Acute bronchitis Acute bronchiolitis due to repiratory syncytial virus (RSV) Acute bronchiolitis due to other infectious organisms Pneumonia due to SARS-associated coronavirus

5 490 Bronchitis, not specified as acute or chronic Simple chronic bronchitis Mucopurulent chronic bronchitis Obstructive chronic bronchitis Emphysematous bleb Other emphysema Extrinsic asthma Intrinsic asthma Chronic obstructive asthma Exercise induced bronchospasm Cough variant asthma Asthma, unspecified Bronchiectasis without acute exacerbation Bronchiectasis with acute exacerbation Extrinsic allergic alveolitis 496 Chronic airway obstruction, not elsewhere classified (COPD) 500 Coal workers' pneumoconiosis (anthracosilicosis, anthacosis, black lung disease, miner's asthma) 501 Asbestosis Pnuemoconiosis due to other silica or sillicates (pnuemoconiosis due to talc, silicotic fibrosis of lung, silicosis) Pneumoconiosis due to inorganic dust (aluminosis, bauxite, berylliosis, graphite fibrosis, siderosis, stannosis) Pneumonopathy due to inhalation of other dust (byssinosis, cannabinosis, flax-dressers disease) 505 Pneumoconiosis, unspecified Chronic and other pulmonary manifestations due to radiation (fibrosis of lung) Pleurisy without mention of effusion or current tuberculosis 515 Post inflammatory pulmonary fibrosis Idiopathic pulmonary fibrosis Lung involvement in systemic sclerosis Lung involvement in other diseases classified elsewhere Pulmonary collapse Acute respiratory failure Chronic pulmonary vascular occlusive disease Other diseases of trachea and bronchus, not elsewhere classified

6 519.4 Disorders of diaphragm Other diseases of respiratory system, not elsewhere classified Systemic lupus erythematosus Rheumatoid lung Kyphosis (acquired) (postural) Scoliosis [and kyphoscoliosis], idiopathic Certain congenital musculoskeletal deformities of spine Pectus excavatum Sleep disturbances Cyanosis Dyspnea and respiratory abnormalities Stridor Cough Abnormal arterial blood gases Nonspecific abnormal findings in lung field Asphyxia (hypoxemia, hypoxia, pulse oximetry showing desaturation) Late effect of adverse effect of drug, medicinal or biological substance Toxic effect of other gases, fumes, or vapors Emphysema (subcutaneous) (surgical) resulting from a procedure V01.82 Exposure to SARS-associated coronavirus V12.6 Personal history of diseases of respiratory system V42.1 Heart transplant V42.6 Lung transplant