Billing and Coding: Respiratory Care

Medicare covers medically necessary respiratory therapy services and specified pulmonary function/spirometry (e.g., 94010–94070, 94150, 94200, 94375, 94640, 94617–94621, 94726–94729) and therapeutic procedures (G0237–G0239), but routine/repetitive or unnecessary batteries of tests are not considered clinically reasonable and CPT 94664 (device demonstration/evaluation) is generally payable only once per beneficiary per provider/group. Key requirements: a specific written order by a physician or appropriate NPP and complete medical record documentation demonstrating the services were reasonable and medically necessary, with adherence to the associated Local Coverage Article (pulmonary rehabilitation) and limits on repeat testing/training.

"If billing just the pulmonary function testing CPT® codes 94070 and 94617-94619 and 94621 together, the following diagnosis codes are allowed: J12."