Billing Codes for Pulmonary Procedures and Asthma Education
For your convenience, below is a chart listing specific pulmonary procedures and their corresponding CPT codes that can be used as a quick reference when billing for asthma care services.
Find more information about the specific pulmonary services and provider responsibilities listed in the chart at the bottom of the page.
| Procedure | CPT Code |
|---|---|
| Pulmonary Function Testing—no bronchodilator | 94010 |
| Pulmonary Function Testing pre and post bronchodilator | 94060 |
| Aerosol treatment (includes demonstration) | 94640 |
| Demonstration | 94664 |
| Oximetry—single determination | 94760 |
| Exercise Oximetry | 94761 |
| A nonphysician healthcare professional uses a standard curriculum to educate a patient about his or her disease or disorder, for example, asthma or diabetes. The healthcare professional spends 30 minutes with an individual patient. | 98960 |
| A nonphysician healthcare professional uses a standard curriculum to educate a patient about his or her disease or disorder, for example, asthma or diabetes. The healthcare professional spends 30 minutes with groups of 2-4. | 98961 |
| A nonphysician healthcare professional uses a standard curriculum to educate a patient about his or her disease or disorder, for example, asthma or diabetes. The healthcare professional spends 30 minutes with groups of 5-8. | 98962 |
| A nonphysician healthcare professional discusses, via telephone, a new health issue and possible treatment or management with an established patient, parent, or guardian. (5-10 minutes) | 98966 |
| A nonphysician healthcare professional discusses, via telephone, a new health issue and possible treatment or management with an established patient, parent, or guardian. (11-20 minutes) | 98967 |
| A nonphysician healthcare professional discusses, via telephone, a new health issue and possible treatment or management with an established patient, parent, or guardian. (21-30 minutes) | 98968 |
| Using online communication technologies, a nonphysician healthcare professional discusses a health issue and possible treatment or management with an established patient. (5 to 10 minutes) | 98970 |
| Using online communication technologies, a nonphysician healthcare professional discusses a health issue and possible treatment or management with an established patient. (11-20 minutes) | 98971 |
| Using online communication technologies, a nonphysician healthcare professional discusses a health issue and possible treatment or management with an established patient. (21 or more minutes) | 98972 |
| Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days (5–10 minutes). | G2061 |
| Qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days (11–20 minutes). | G2062 |
| Qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days (21 or more minutes). | G2063 |
The specific pulmonary services and physician responsibilities listed in the chart above are described below:
Aerosol Treatment
The code for aerosol treatment includes aerosol demonstration. If the demonstration is provided separately, it can be billed as a separate service with adequate documentation and use of the modifier 59 to alert the payer that it is a distinct and separate service. Always consult the payer’s billing and payment rules.
Pulmonary Function Testing
Spirometry is a critical component for diagnosing and managing pulmonary disease.The test allows the physician to evaluate the degree of airway obstruction, the effectiveness of the current therapy, and gives the opportunity to customize medications to ensure adequate daily control.Test results are available immediately following the procedure for evaluation and interpretation.
Scheduling, interpretation of the PFT, nebulizer set-ups, compressor, liquid or inhaled albuterol for inhalation, and normal saline is supplied by the physician’s office. Most payers cover this service.
Demonstration
During this session patients should be taught and expected to adequately demonstrate inhaler and spacer technique. Patients should bring their inhaler and spacer with them for teaching. This takes approximately 15 minutes. Services may be provided by, and under the delegation and supervision of a provider (physician, physician assistant, nurse practitioner, or clinical nurse specialist). Office staff such as nurses and respiratory therapists may provide the assessment and education.
Services must be billed by a physician, physician assistant, nurse practitioner or clinical nurse specialist. Four (4) session per year are allowed with only one session per day, maximum of two (2) sessions in a six (6)-month period. See documentation requirements (pdf). You should consult the payer’s billing and payment rules.
The physician or other clinical staff are responsible for scheduling the appointment and for prescribing the medication(s) and spacer for the patient. Most payers cover spacers. They may be covered as a pharmacy benefit or may be considered durable medical equipment.
Pulse Oximetry
This simple and painless procedure is done to evaluate oxygen levels of the patient. It is recommended for any patient that is in respiratory distress. For a patient that suffers with COPD, oximetry while walking may be required. Most payers cover this service.