Does 99291 require prior authorization?

No, 99291 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 99291?

Medicare facility rate: $199.07. Non-facility rate: $308.96. Work RVU: 4.50.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

4.50

Facility

$199.07

Non-Facility

$308.96

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.
Claims must document that the physician personally performed the service or that ancillary personnel were employed by the physician and the physician provided direct personal supervision and performed initial and subsequent services demonstrating active participation and management.
Medical records must document the clinical signs/symptoms or diagnoses justifying pulse oximetry (e.g., tachypnea, dyspnea, cyanosis, respiratory distress, confusion, hypoxia, chronic lung disease, cardiopulmonary disease, neuromuscular respiratory disease, trauma, chest pain, or therapy with pulmonary toxicity) and state the specific reason for testing (initial evaluation, acute change, exercise tolerance, or oxygen therapy necessity).

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.
Respiratory therapy services are covered when rendered as an integral and incidental part of a physician's professional services during diagnosis or treatment of an injury or illness.
Respiratory therapy is covered for acute respiratory disease or acute exacerbation of chronic respiratory disease.
Selected chronic stable respiratory conditions may be covered when respiratory therapy is medically necessary for that individual patient.
Respiratory therapy in a nursing facility or office is payable to a physician if the service is personally performed by the physician or a qualified non-physician practitioner (NPP) within the scope of their license.

A56730 — Billing and Coding: Respiratory Therapy and Oximetry Services

L33446 — Respiratory Therapy and Oximetry Services

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