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Wiki Billing for 94760 pulse oximetry
- Thread starter maryperry
- Start date
Teresa Collins
Guru
It has been my experience that insurance companies do not reimburse separately for 94760 even when modifier 25 is used on the E/M. They tend to bundle it with the E/M code.
I hope this helps!
Teresa Collins, CPC
I hope this helps!
Teresa Collins, CPC
abbyfraise
Guest
- Messages
- 8
- Best answers
- 0
You can not bill 94760 with an office visit. The insurance companies will deny because they consider it part of the constitutional. We were at one time billing both and were ALWAYS denied the pulse ox.
94760 is a Medicare status T code, which says :
There are RVUs and payment amounts for these services, but they are only paid if there are no other services payable under the physician fee schedule billed on the same date by the same provider. If any other services payable under the physician fee schedule are billed on the same date by the same provider, these services are bundled into the physician services for which payment is made.
Which basically means if the E/M is payable for the same DOS, then this 94760 code is not going to be.
There are RVUs and payment amounts for these services, but they are only paid if there are no other services payable under the physician fee schedule billed on the same date by the same provider. If any other services payable under the physician fee schedule are billed on the same date by the same provider, these services are bundled into the physician services for which payment is made.
Which basically means if the E/M is payable for the same DOS, then this 94760 code is not going to be.
Brandy0618
Guru
Rules vs Right?
So, if our Dr states she wants 94760 on the claim since they actually did it, even though it will it not get paid, what is RIGHT? Thank you, Brandy
So, if our Dr states she wants 94760 on the claim since they actually did it, even though it will it not get paid, what is RIGHT? Thank you, Brandy
Pam Warren
True Blue
Billing the 94760 with an E&M could be considered 'unbundling'. I'd leave it off the claim.
Brandy0618
Guru
Thank you so much Pam...I appreciate you taking the time to help me! God Bless, Brandy, CPC
MarcusM
Expert
Pulse oximeter charges used to be paid, back when the equipment was expensive. Advise your doctor that now a pulse ox is similar to taking a blood pressure reading, and you don't charge separate for that tool. The pulse ox is part of the diagnostics that aids in medical decision making, complexity, and the lower the pulse ox reading, then the more complicated the medical decision making. So it is fair to be part of the E & M CPT, just make sure the documentation supports the level of coding.
Brandy0618
Guru
Thank u
Thank you for taking your time to respond to my question? You pointed out some great points!! Im never disappointed when I post my questions here....you guys ALWAYS DELIVER!! Thank you so much!
Thank you for taking your time to respond to my question? You pointed out some great points!! Im never disappointed when I post my questions here....you guys ALWAYS DELIVER!! Thank you so much!
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94760 for vitals
Should CPT codes 94760, A4670 AND 2010F be used for taking vitals? (this is for ER department coding
Thank you,
Debbie
Should CPT codes 94760, A4670 AND 2010F be used for taking vitals? (this is for ER department coding
Thank you,
Debbie
JuarezD
Contributor
resouces
Hello,
Do you have any resources where I can find this information in writing?
Hello,
Do you have any resources where I can find this information in writing?