Does 94640 require prior authorization?

No, 94640 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 94640?

Medicare facility rate: $8.68. Non-facility rate: $8.68. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

$8.68

Non-Facility

$8.68

Claims must follow the complementary Local Coverage Determination (LCD L34430) and, when CPT 97000–97799 are used by PT/OT, must include documentation that the services meet the coverage and documentation requirements for physical or occupational therapy.
Supporting documentation must demonstrate that CPT 31720 was personally performed by the physician or qualified NPP when billing that code.
For consecutive days of respiratory therapy, the medical record must document why the patient was not transferred to a higher level of care.
A specific written order (referral/prescription) by the physician or appropriate NPP must be on file for all respiratory care services.

Therapeutic procedures whose principal aim is to treat a respiratory impairment must be billed using HCPCS codes G0237, G0238, or G0239.
CPT 94762 is medically necessary when intermittent arterial blood gas sampling is likely to miss important variations in the patient's respiratory status.
CPT 94762 is medically necessary when the patient has hypoxemia and there is a need to assess supplemental oxygen requirements and/or a therapeutic oxygen regimen.
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.

AETNA-CPB-0479 — Respiratory Devices: Incentive Spirometers, Vaporizers and Intermittent Positive Pressure Breathing Machines

A56717 — Billing and Coding: Respiratory Therapy (Respiratory Care)

A56730 — Billing and Coding: Respiratory Therapy and Oximetry Services

A57224 — Billing and Coding: Respiratory Care

L34430 — Respiratory Therapy (Respiratory Care)

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