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) 645-2891. 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 94010 Spirometry, including graphical record vital capacity, expiratory flow rate $33 per test with or without maximal voluntary ventilation 94060 Bronchodilator responsiveness $55 per test pre and post administration
94375 Flow Volume Loop $36 per test (cannot be used with 94010 or 94060 Pulse Oximetry CPT Codes CPT Code 94760 94761 94762 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, 94720 Low High Description 011.00 011.06 Tuberculosis of lung, infiltrative 011.10 011.16 Tuberculosis of lung, nodular 011.20 011.26 Tuberculosis of lung with cavitation 011.30 011.36 Tuberculosis of bronchus 011.40 011.46 Tuberculous fibrosis of lung 011.50 011.56 Tuberculous bronchiectasis 011.60 011.66 Tuberculous pneumonia (any form) 011.70 011.76 Tuberculous pnuemothorax 011.80 011.86 Other specified pulmonary tuberculosis 011.90 011.96 Pulmonary tuberculosis, unspecified 012.00 012.06 Tuberculous pleurisy 012.10 012.16 Tuberculosis of intrathoracic lymph nodes 012.20 012.26 Isolated thracheal or bronchial tuberculosis 012.30 012.36 Tuberculous laryngitis 012.80 012.86 Other specified respiratory tuberculosis
031.0 Diseases due to other mycobacteria, pulmonary 039.1 Actinomycotic infections; pulmonary 045.00 045.03 Acute paralytic poliomyelitis specified as bulbar 079.82 SARS-associated coronavirus 114.0 Primary coccidioidomycosis (pulmonary) 116.0 Blastomycosis 117.0 Sporotrichosis 117.5 Cryptococcosis 135 Saroidosis 138 Late effects of acute poliomyelitis 162.0 Malignant neoplasm of trachea 162.2 Malignant neoplasm of main bronchus 162.3 Malignant neoplasm of upper lobe, bronchus or lung 162.4 Malignant neoplasm of middle lobe, bronchus or lung 162.5 Malgnant neoplasm of lower lobe, bronchus or lung 162.8 Malignant neoplasm of other parts of bronchus or lung 162.9 Malignant neoplasm of bronchus and lung, unspecified 163.0 Malignant neoplasm of parietal pleura 163.1 Malignant neoplasm of visceral pleura 163.8 Malignant neoplasm of other specified sites of pleura 163.9 Malignant neoplasm of pleura, unspecified 164.0 Malignant neoplasm of thymus 164.1 Malignant neoplasm of heart 164.2 Malignant neoplasm of anterior mediastinum 164.3 Malignant neoplasm of posterior mediastinum 164.8 Other malignant neoplasm 164.9 Malignant neoplasm of mediastinum, part unspecified 165.0 Malignant neoplasm of upper repiratory tract, part unspecified 165.8 Malignant neoplasm of other and ill defined sites within the repiratory system and intrathoracic organs 197.0 Secondary malignant neoplasm of lung 212.3 Benign neoplasm of bronchus and lung 212.4 Benign neoplasm of pleura 212.5 Benign neoplasm of mediastinum 228.1 Pulmonary lymphangioma, any site 231.2 Carcinoma in situ, bronchus and lung
235.7 Neoplasm of uncertain behavior, trachea, bronchus, and lung 239.1 Neoplasm of unspecified nature of the respiratory system 277.00 Cystic fibrosis; without mention of meconium ileus 277.01 Cystic fibrosis; with meconium ileus 277.02 Cystic fibrosis; with pulmonary manifestations 277.03 Cystic fibrosis; with gastrointestinal manifestations 277.09 Cystic fibrosis; with other manifestations 277.81 Primary carnitine deficiency 277.82 Carnitine deficiency due to inborn errors of metabolism 277.83 latrogenic carnitine deficiency 277.84 Other secondary carnitine deficiency 277.89 Other specified disorders of metabolism 289.0 Polycythemia, secondary 335.20 Amyotrophic lateral sclerosis 344.89 Other specified paralytic syndrome 357.0 Acute Infective polyneuritis 358.00 Myastheniagravis without (acute) exacerbation 358.01 Myastheniagravis with (acute) exacerbation 359.1 Hereditary progressive muscular dystrophy 415.11 latrogenic pulmonary embolism and infarction 415.19 Other pulmonary embolism and infarction 416.0 Primary pulmonary hypertension 416.1 Kyphoscoliotic heart disease 416.8 Other chronic pulmonary heart diseases 416.9 Chronic pulmonary heart disease, unspecified 428.0 Congestive heart failure, unspecified 428.1 Left heart failure 428.20 428.23 Systolic heart failure 428.30 428.33 Diastolic heart failure 428.40 428.43 Combined systolic and diastolic heart failure 428.9 Heart failure unspecified 466.0 Acute bronchitis 466.11 Acute bronchiolitis due to repiratory syncytial virus (RSV) 466.19 Acute bronchiolitis due to other infectious organisms 480.3 Pneumonia due to SARS-associated coronavirus
490 Bronchitis, not specified as acute or chronic 491.0 Simple chronic bronchitis 491.1 Mucopurulent chronic bronchitis 491.20 491.21 Obstructive chronic bronchitis 492.0 Emphysematous bleb 492.8 Other emphysema 493.00 493.02 Extrinsic asthma 493.10 493.12 Intrinsic asthma 493.20 493.22 Chronic obstructive asthma 493.81 Exercise induced bronchospasm 493.82 Cough variant asthma 493.90 493.92 Asthma, unspecified 494.0 Bronchiectasis without acute exacerbation 494.1 Bronchiectasis with acute exacerbation 495.0 495.9 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 502 503 504 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 508.1 Chronic and other pulmonary manifestations due to radiation (fibrosis of lung) 511.0 Pleurisy without mention of effusion or current tuberculosis 515 Post inflammatory pulmonary fibrosis 516.3 Idiopathic pulmonary fibrosis 517.2 Lung involvement in systemic sclerosis 517.8 Lung involvement in other diseases classified elsewhere 518.0 Pulmonary collapse 518.81 Acute respiratory failure 518.89 Chronic pulmonary vascular occlusive disease 519.1 Other diseases of trachea and bronchus, not elsewhere classified
519.4 Disorders of diaphragm 519.8 Other diseases of respiratory system, not elsewhere classified 710.0 Systemic lupus erythematosus 714.81 Rheumatoid lung 737.10 Kyphosis (acquired) (postural) 737.30 Scoliosis [and kyphoscoliosis], idiopathic 754.2 Certain congenital musculoskeletal deformities of spine 754.81 Pectus excavatum 780.50 780.57 Sleep disturbances 782.5 Cyanosis 786.00 786.09 Dyspnea and respiratory abnormalities 786.1 Stridor 786.2 Cough 790.91 Abnormal arterial blood gases 793.1 Nonspecific abnormal findings in lung field 799.0 909.5 Asphyxia (hypoxemia, hypoxia, pulse oximetry showing desaturation) Late effect of adverse effect of drug, medicinal or biological substance 987.0 987.9 Toxic effect of other gases, fumes, or vapors 998.81 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