Billing and Coding: Respiratory Care

Medicare covers respiratory care and pulmonary function testing only when there is a specific written order by a physician or appropriate NPP and the service is documented as reasonable and medically necessary. Covered procedures include specified CPT/HCPCS codes for spirometry, lung volumes, diffusion capacity, pulmonary stress testing, and therapeutic respiratory procedures, provided testing meets ATS standards (e.g., spirometry with three acceptable attempts) and required reports and physician signatures are on file; CPT 94664 is typically payable once per beneficiary per provider/group except in extenuating circumstances.

"Therapeutic respiratory procedures (HCPCS G0237, G0238, G0239) using an individualized physical conditioning and exercise program with breathing techniques are covered for patients with documented ..."

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