Does 94619 require prior authorization?

No, 94619 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 94619?

Medicare facility rate: $66.80. Non-facility rate: $66.80. Work RVU: 0.48.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.48

Facility

$66.80

Non-Facility

$66.80

Billing and coding for pulmonary stress testing must follow Local Coverage Determination (LCD) L33444; consult LCD L33444 for specific medical necessity, coding, and billing criteria.
This article provides billing, coding, or other guidelines that complement LCD L33444 rather than standalone coverage criteria.
A specific written order (referral/prescription) by the physician or appropriate NPP must be on file for all respiratory care services.
Medical records must fully document that services were reasonable and medically necessary, with results and usage of the test documented in the record and available upon request.

Therapeutic respiratory procedures (HCPCS G0237, G0238, G0239) using an individualized physical conditioning and exercise program with breathing techniques are covered for patients with documented activity limitations.
Pulmonary function tests (PFTs) represented by CPT codes 94070, 94200, 94640, 94726, 94727, and 94729 are covered when reasonable and medically necessary with supporting clinical documentation and a written order by a physician or appropriate NPP.
Spirometry (CPT 94010, 94011, 94012, 94060, 94070, 94150, 94200, 94375, 94726, 94727) is covered when clinically indicated and documented in the medical record.
Lung volume determination (CPT 94013, 94726, 94727, 94728) and diffusion capacity testing (CPT 94729) are covered when medically necessary and documented.
Pulmonary stress testing (CPT 94617, 94618, 94619, 94621) is covered when clinically indicated and supported by the medical record.
Device demonstration and/or evaluation (CPT 94664) is covered when used for device demonstration/evaluation purposes and documented as such in the medical record.

L33693 — Peripheral Venous Ultrasound

J09

L35007 — Vestibular and Audiologic Function Studies

J12

L35434 — Oximetry Services

J12

L35451 — Peripheral Venous Ultrasound

J12

A53252 — Billing and Coding: Independent Diagnostic Testing Facility (IDTF)

Ask Verity about documentation requirements, denial risks, or coverage in your state.