Page 1 of 2 12 LastLast
Results 1 to 10 of 11

Billing for 94760 pulse oximetry

  1. #1
    Default Billing for 94760 pulse oximetry
    New Call-to-action
    Can you bill 94760 with an E&M visit and do you need to use mod-25?
    We have not been billing for 94760 but plan on starting.

  2. #2
    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

  3. Default
    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.

  4. #4
    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.

  5. #5
    Default 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

  6. #6
    Dover Seacoast New Hampshire
    Billing the 94760 with an E&M could be considered 'unbundling'. I'd leave it off the claim.
    Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

  7. #7
    Thank you so much Pam...I appreciate you taking the time to help me! God Bless, Brandy, CPC

  8. #8
    Austin, Texas
    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.

  9. #9
    Thumbs up 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 guys ALWAYS DELIVER!! Thank you so much!

  10. Default 94760 for vitals
    Should CPT codes 94760, A4670 AND 2010F be used for taking vitals? (this is for ER department coding

    Thank you,

Page 1 of 2 12 LastLast

Similar Threads

  1. 94760 - pulse oximetry
    By klevy07 in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 09-13-2015, 08:55 PM
  2. Pulse Oximetry 94760 and 94761
    By AR2728 in forum Auditing General Discussion
    Replies: 0
    Last Post: 03-19-2013, 01:43 PM
  3. Billing pulse-ox 94760
    By bonncruise in forum Billing/Reimbursement
    Replies: 2
    Last Post: 08-16-2012, 02:44 PM
  4. Billing for pulse ox interp 94760 in the urgent care setting
    By Lock in forum Outpatient Facilities
    Replies: 1
    Last Post: 01-23-2012, 01:38 PM
  5. Billing for Overnight Pulse Oximetry
    By sjmccarl52 in forum Orthopaedics
    Replies: 0
    Last Post: 08-15-2008, 01:10 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.