tci ED Coding & Reimbursement Alert - 2016 Issue 4

Reader Question: Breathe Easy When You Know the Payment Policy for Pulse Oximetry

Question: Can we bill for a pulse oximetry? I’ve heard it both ways. What about just reporting the interpretation? Nevada subscriber Answer: CMS does not recognize 94760 as a payable service in a facility setting. Even in an office setting it is only payable when it is the only service provided on a calendar day. Historically, physicians providing a pulse oximetry interpretation in a setting where they did not own the equipment would report 94760 with modifier 26 to indicate that they were providing only the interpretation on the test and not the technical component. However, CPT® and...

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