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95012- exhaled nitric oxide

  1. #1
    Default 95012- exhaled nitric oxide
    Medical Coding Books
    Hello to all,
    We are an Allergy office in Massachusetts and we are thinking about doing Exhaled Nitric Oxide measurements (95012). I know that Medicare reimburses the procedure but cannot get a straight answer from other payors (Tufts,Harvard, BCBS etc) as to whether they will reimburse for the procedure.Two other Allergy offices said that payors are denying on the grounds that it is experimental.

    Is anyone performing this procedure and if so are payors other than Medicare reimbursing? Also how are you billing it? The procedure is done usually on the same day after Bronchospasm Evaluation (94060). I am thinking it may need to be billed with a modifier 59 along with E&M and Modifier 25.

    Thank You,
    Christine Barboza, CPC

  2. #2
    I work for an Allergy and Immunology office in Tulsa, OK. We recently began doing the exhaled nitrous oxide in our office. We have gotten denials from a couple of our largest payors, United Health Care and Aetna, stating the test is not medically necessary. I have used a modifier 25 on the E&M code, but not the 59 modifier, although that makes sense. The denials we have gotten were not due to modifiers unfortunately. That could have been an easy fix. I was told that someone in our office checked with our major carriers prior to our purchasing the equipment and that person was confident that we would be reimbursed. All of my rambling is leading up to my saying, please check it our more thoroughly than we did.

    Allergy offices are few and far between. I will keep your email address for future reference. Please feel free to do the same.

    Ann Winters, CPC - Allergy Clinic of Tulsa, Inc. (918) 307-1613

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