pulse oximetry

cmac

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we bill cpt 94760 and/or 94761 - usually 94760 which is for pulse oximetry. in almost all instances of our denials the patient has come in and complained of shortness of breath and the dr ordered a pulse oximetry. 786.05 is a covered dx per the LCD but our denial is C0-B15 which is payment included in allowance for another procedure. they are saying it's included with the office call. the LCD is a little unclear to me whether it's covered under PART B or not or if it's only allowed in a hospital setting not a physican's office.
Does anyone know anything about this? what's covered, what's not? I have been transferred to a level 2 person @ medicare 2 days in a row and have been on hold for an hour and a half each time, any insight would be helpful at this point!
Thanks!
 

scorrado

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Bridgewater, VA
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In my experience Pulse ox is always included in the office visit. I have never seen one get paid. Maybe others have a trick I dont know about, but from what I understand it is included in the visit.
 

Cottrell

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north seattle wa
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This is from the pulse ox LCD
"Procedures 94760 and 94761 are considered by CMS to be laboratory procedures. Therefore, they are technical services and are not payable to a physician/provider in an inpatient or outpatient hospital setting."

We do the overnight pulse ox and have been getting paid for that-94762.

Hope this helps
 
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Hope you can help ! I am finding that 94762 can only use a TC modifier. Do you bill the 94762 without the 26 (global) and get paid? Medicare, BC, any others?

Thanks for the help
 
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