Wiki Nebulizer treatment

[gchurch2018]

Can you advise on how to bill an in office nebulizer treatment? I know the correct code is 94640 although some payers are no longer paying for this service. Can 94664 be billed by the office nurse or is this code only to be used by respiratory therapy?

 

[mitchellde]

I have not had any problem with payers paying for 94640. When you say they are not paying for it, then what is the reason being given.
Do not substitute one code for another. Which service was rendered, the 94640 or 94664? If the nebulozer (94660) was the service rendered then we need to figure out why reimbursement is not coming.

 

[HangarPilot]

We also bill 94640 with no issues (although the E/M requires a -25 modifier).

When a second treatment is needed we also successfully bill a second 94640 on a separate line with -76 (Repeat Procedure) modifier.

94664 is for demonstrating how to use a neutralizer (patient education), but you cannot bill that with 94640 because it's considered part of the treatment. You could only use that if you did demonstration/evaluation/education without giving a treatment.

 

[TJAlexander]

94640

Can you advise on how to bill an in office nebulizer treatment? I know the correct code is 94640 although some payers are no longer paying for this service. Can 94664 be billed by the office nurse or is this code only to be used by respiratory therapy?

I too am receiving denials for 94640, specifically for Aetna Medicare. Its denied with CO-96; Non-covered charge. However, according to Aetna's Clinical Policy Bulletin, it is considered medically necessary to administer Albuterol so I'm submitting an appeal. I'll keep you updated on the results but am interested to hear if anyone else if having this issue.

 

[marscott75@gmail.com]

I know this is an old thread but I'm having problems with billing 99203 and 94640 to Medicare. The denial states :This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements. Is there anyway you can please help. Thank you

 

[kschulte71]

94640 Error states max units 1 per day

We are having issues with Medicare denying an observation claim due to multiple neb tx's in a day. It states cannot exceed 1 unit per day. Would a mod -76 help us with this denial?