PFTs measure the ability of the lungs to use air. The results help diagnose breathing problems.
Reimbursement is available for medically necessary PFTs. Spirometry ranks as the most common PFT. CPT codes describe the various PFTs, many of which are components of spirometry. Bill PFTs with the appropriate CPT code from the range
94010-94799. The most commonly billed PFTs codes include:
94010 -- spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation
94060 -- bronchospasm evaluation; spirometry as in 94010, before and after bronchodilator (aerosol or parenteral)
94070 -- prolonged postexposure evaluation of bronchospasm with multiple spirometric determinations after antigen, cold air, methacholine or other chemical agent, with subsequent spirometrics
94014 -- reinforced education, transmission of spirometric tracing, data capture, analysis of transmitted data, periodic recalibration and physician review and interpretation
94015 -- recording (includes hook-up, reinforced education, data transmission, data capture, trend analysis, and periodic recalibration)
94016 -- physician review and interpretation only.
Codes 94014, 94015 and 94016 will be paid once in a 30-day period. Medicare reimburses initial hospital and office consults, initial hospital visits, and new-patient office visits, in addition to PFTs when performed on the same day. Medicare also reimburses follow-up or subsequent E/M services in addition to PFTs when the E/M service is for a significant, separately identifiable condition. Bill the PFTs appending modifier -25 to the appropriate E/M code.
Documentation must be in the clinical record to support the use of the E/M codes. If two or more spirometry codes are billed on the same date of service, Medicare will reimburse only one.
Bill a methacholine challenge test using code 95070 (inhalation bronchial challenge testing [not including necessary pulmonary function tests]; with histamine, methacholine or similar compounds) when performed with spirometry. Medicare will not reimburse the administration of methacholine without spirometry.