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Thread: nebulizer reimbursement (94640)

  1. #11
    Join Date
    Apr 2007

    Default nebulizer

    AAPC: Back to School
    I use 25 mod for the e & M code and 59 on 96040 . You can call me tomorrow at 336-358-1528 and they will give you the number that I will be at in the morning.
    [I]Elizabeth Comma-Watson, CPC
    Billing/Coding Specialist
    Greensboro, NC 27455-2601

  2. #12

    Default Nebulizer

    When you code the nebs, do you look up the LCD to make sure the diagnosis you used is covered? Some will not pay if it is not an acute bronchitis, if the doctor diagnosis bronchitis, 490, look at the documentation, did the patient have abnormal breath sounds or bronchospasms diagnosed? If so, that code can be used to get the treatment paid. That is what we have found with ours, along with use of the 25 modifier.

  3. #13


    yes, we have a cheat sheet with what codes are covered for the nebs. These darn insurances hehe

  4. #14


    Just to keep the threads consistent, I wanted to add to this poll.. Does anyone know if neb supplies, like A7003: Admin set should be assigned in addition to the neb treatment (94640) or does the code include the cost of the supply?

    Thank you!

  5. #15


    the medication is inclusive in the treatment.
    some providers have an agreement with the pharmaceutical provider about the medication at lower cost when they use it.
    try to get your office manager to work on it with the pharmaceutical provider

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