Pulmonology Coding Alert

Reader Question:

Initiate CPAP

Question: Our doctor interprets sleep studies in a hospital outpatient center. If he decides to call the patient and initiate CPAP (94660), can he bill for it? He is not seeing the patient in the center.

Illinois Subscriber

Answer: No, the physician cannot bill for CPAP in this scenario. CPT code 94660 (continuous positive airway pressure ventilation [CPAP], initiation and management) requires a face-to-face encounter with the patient in order to bill the service, unlike an interpretation of a diagnostic test such as a patient-initiated spirometric recording for 30 days (CPT 94014), which has a CPT code specifically for the professional component. Professional components do not require a face-to-face encounter with the patient.
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