Procedure code and Description
- 94640 – Pressurized or non-pressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device
❖ 94644 – Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour (For services of less than 1 hour, use 94640)
❖ 94060 – Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration(Do not report 94060 with 94150, 94200, 94375, 94640, 94728) (Report bronchodilator supply separately with 99070 or appropriate supply code)
❖ 94070 – Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents (e.g., antigen[s], cold air, methacholine. (Report antigen(s) administration separately with 99070 or appropriate supply code)
(Do not report in conjunction with 94640)
Billing Guidelines from Medicare
CPT code 94060 (Bronchodilation responsiveness, spirometry as in 94010, preand post-bronchodilator administration) describes a diagnostic test that is used to assess patient symptoms that might be related to reversible airway obstruction. It does not describe treatment of acute airway obstruction. CPT code 94060 includes the administration of a bronchodilator. It is a misuse of CPT code 94640 (Pressurized or non-pressurized inhalation treatment for acute airway obstruction… (IPPB) device) to report 94640 for the administration of the bronchodilator included in CPT code 94060. The bronchodilator medication may be reported separately .
CPT code 94640 (Pressurized or non-pressurized inhalation treatment for acute airway obstruction… (IPPB) device) describes either treatment of acute airway obstruction with inhaled medication or the use of an inhalation treatment to induce sputum for diagnostic purposes. CPT code 94640 shall only be reported once during an episode of care regardless of the number of separate inhalation treatments that are administered. If CPT code 94640 is used for treatment of acute airway obstruction, spirometry measurements before and/or after the treatment(s) shall not be reported separately. It is a misuse of CPT code 94060 to report it in addition to CPT code 94640. The inhaled medication may be reported separately.
An episode of care begins when a patient arrives at a facility for treatment and terminates when the patient leaves the facility. If the episode of care lasts more than one calendar day, only one unit of service of CPT code 94640 shall be reported for the entire episode of care.
If a patient receives inhalation treatment during an episode of care and returns to the facility for a second episode of care that also includes inhalation treatment on the same date of service, the inhalation treatment during the second episode of care may be reported with modifier 76 appended to CPT code 94640
If inhalation drugs are administered in a continuous treatment or a series of “back-to-back” continuous treatments exceeding one hour, CPT codes 94644 (Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour) and 94645 (…; each additional hour) may be reported instead of CPT code 94640.
CPT code 94640 (Pressurized or non-pressurized inhalation treatment for acute airway obstruction… (IPPB) device) and CPT code 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator… (IPPB) device) generally should not be reported for the same patient encounter. The demonstration and/or evaluation described by CPT code 94664 is included in CPT code 94640 if it uses the same device (e.g., aerosol generator) that is used in the performance of CPT code 94640. If performed at separate patient encounters on the same date of service, the 2 services may be reported separately.
Aerosol Treatment
Nebulized aerosol treatments (procedure codes 94640, 94644, and 94645) with short-acting betaagonists are a benefit of Texas Medicaid and considered medically necessary when breathing is compromised by certain acute medical conditions. Documentation to support an aerosol treatment for the worsening of an acute or chronic condition must be maintained in the client’s medical record and is subject to retrospective review.
Procedure code 94645 is only a benefit in the outpatient setting, specifically in a hospital emergency department or an urgent care clinic.
Pulse oximetry and evaluation of the client’s use of an aerosol generator, nebulizer, or metered-dose inhaler are considered part of an evaluation and management (E/M) visit and will not be reimbursed separately.
Hypertonic saline used in aerosol therapy will be denied if billed separately
Inhalation Treatment for Acute Airway Obstruction
CPT code 94640 describes treatment of acute airway obstruction with inhaled medication and/or the use of an inhalation treatment to induce sputum for diagnostic purposes.
Hospital inpatient services: If more than one inhalation treatment is performed on the same date of service, the code should be reported by appending modifier 76. If inhalation drugs are administered in a continuous treatment or a series of “back-to-back” treatments exceeding one hour, CPT codes 94644 and 94645 should be reported instead of CPT code 94640. When providing inhalation treatment for acute airway obstruction, Medicare will not pay for both 94640 and 94644 or 94645 if they are billed on the same day for the same patient. The coder must decide which of the two codes to submit.
Hospital outpatient services, such as emergency departments: If inhalation treatments are administered in an outpatient setting, the use of CPT code 94640 is subject to NCCI edits which are described on pages 1 and 2 of these guidelines. This means CPT code 94640 shall only be reported once during an episode of care regardless of the number of separate inhalation treatments that are administered. If CPT code 94640 is used for treatment of acute airway obstruction, spirometry measurements before and/or after the treatment(s) shall not be reported separately. It is a misuse of CPT code 94060 to report it in addition to CPT code 94640. The inhaled medication may be reported separately. An episode of care begins when a patient arrives at a facility for treatment and terminates when the patient leaves the facility. If the episode of care lasts more than one calendar day, only one unit of service of CPT code 94640 shall be reported for the entire episode of care.
If a patient receives inhalation treatment during an episode of care and returns to the facility for a second episode of care that also includes inhalation treatment on the same date of service, the inhalation treatment during the second episode of care may be reported with modifier 76 appended to CPT code 94640.
If you have questions about the use of CPT code 94640 or use of modifier 76 (repeat procedure or service by the same physician or other qualified health care professional), we strongly recommend you check with the coding and billing representatives at your facility. If further clarification is necessary, the facility should check with the Medicare contractor that pays its claims.
Section J – Pulmonary Services
• “If inhalation drugs are administered in a continuous treatment or a series of “back-to-back” continuous treatments exceeding one hour, CPT codes 94644 (continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour) and 94645 (…; each additional hour) may be reported instead of 94640.
Which Code Do I Remove?
• Chapter 11 Section J – Pulmonary Services
• “CPT code 94640 (pressurized or non-pressurized inhalation treatment for acute airway obstruction…) and CPT code 94664 (demonstration and/or evaluation of patient utilization of an aerosol generator…) generally should not be reported for the same patient encounter.
Which Code Do I Remove?
• Chapter 11 Section J – Pulmonary Services
• “The demonstration and/or evaluation described by CPT code 94664 is included in CPT code 94640 if it utilizes the same device (e.g., aerosol generator) that is used in the performance of CPT code 94640. If performed at separate patient encounters on the same date of service, the two services may be reported separately.”
