Primary Care Coding Alert

Question: When will insurers pay for pulse oximetry? May I report 94760 with other procedures?


Florida Subscriber


Answer: You should check your major insurers' pulse oximetry guidelines before reporting this code (94760, Noninvasive ear or pulse oximetry for oxygen saturation; single determination; 94761, ... multiple determinations [e.g., during exercise]).

Reason: Medicare and many commercial insurers have developed different policies for 94760 and 94761. Therefore, no set of guidelines applies to all family physician practices.
 
Examples: First Coast Service Options, Florida and Connecticut's Medicare carrier, bundles 94760 with 94761 when the physician performs the services on the same day. Also, FCSO will not pay for either 94760 or 94761 with any other Physician Fee Schedule service 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.

Exception: Trailblazer Health Enterprises of Texas' policy, however, does not state that the codes will be bundled with other services. But Trailblazer specifies  ICD-9 requirements that practices must meet.

If you're billing a commercial insurer, you will be subject to its guidelines.