Pulmonology Coding Alert

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


Texas Subscriber

Answer: The Medicare Physician Fee Schedule assigns a "T" status to 94760 (Noninvasive ear or pulse oximetry for oxygen saturation; single determination) and 94761 (... multiple determinations). Medicare, as well as those commercial insurers that follow Medicare guidelines, prohibits you from using 94760 and 94761 on the same day as any other service that payers reimburse under the Physician Fee Schedule. If pulse oximetry was the only service provided on a given date, the physician is able to report and be paid for 94760 or 94761.

If you're billing a commercial insurer, you will be subject to its guidelines. Be sure to check with your individual payers.