Internal Medicine Coding Alert

Question: Under what circumstances will insurers reimburse 94760? Can we report this code with other procedures?

North Carolina Subscriber

Answer: Your best bet is to check with your local carrier before reporting this code. That's because many Medicare and commercial insurers have developed different coverage policies for oximetry code 94760 (Noninvasive ear or pulse oximetry for oxygen saturation; single determination), so no set of guidelines will apply to all IM practices.
 
For example, First Coast Service Options (FSCO), Florida and Connecticut's Medicare carrier, bundles 94760 in with multiple determination oximetry code 94761 (... multiple determinations [e.g., during exercise]) when the physician performs the services on the same day. Also, FSCO will not pay for either 94760 or 94761 with any other Physician Fee Schedule services you bill on the same day.
 
Noridian Medicare, which covers several states, including North Dakota and Nevada, also bundles 94760 and 94761 with other payable services. Trailblazer Health Enterprises of Texas' policy, however, does not state the codes will be bundled with other services. But Trailblazer specifies ICD-9 requirements practices must meet.
 
If you're billing a commercial insurer, you will be subject to its guidelines.