Sensaire® Reimbursement
Printable version of Spirometry reimbursement.
Source: November 2006 Federal Register publications of Final Rule Medicare Program’s Fee Schedule for Physician’s Services for Calendar Year 2007 and the Tax Relief and Health Care Act of 2006.
The following common procedure terminology codes (CPT Codes) describe the various spirometric procedures and the national average reimbursement amount. They include, but are not limited to:
| Comprehensive Code | Component Code |
Description | National Fee |
| 94010 | 00520, 94200, 94375, 95070, 95071 |
Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without MVV. | $33.32 |
| 94014 | 00520, 94010, 94015, 94016, 94200, 94375 |
Patient-initiated spirometric recording per 30 day period of time; includes reinforced education, transmission of spirometric tracings, data capture, analysis of transmitted data, periodic recalibration and physician review and interpretation. | $48.66 |
| 94015 | 00520, 94010, 94200, 94375 |
Patient-initiated spirometric recording per 30 day period of time; recording (includes hook up, reinforced education, data transmission, data capture, trend analysis and periodic recalibration). | $23.79 |
| 94016 | 00520, 94015, 94375 |
Patient-initiated spirometric recording per 30 day period of time; physician review and interpretation only. | $24.87 |
| 94060 | 00520, 36000, 36410, 94010, 94200, 94375, 94640, 94664, 94770, 95071 |
Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration. |
$56.61 |
| 94150 | Vital capacity; total (separate procedure). | $21.28 | |
| 94200 | Maximum breathing capacity, maximal voluntary ventilation (MVV). | $22.18 | |
| 94375 | 00520 | Respiratory Flow Volume Loop. | $36.00 |
| S8190 | HCPC Code for Electronic Spirometer | ||
| 94620 | 00520, 93015, 93016, 93017, 93018, 93041, 93042, 94010, 94060, 94200, 94250, 94680, 94681, 94690, 94760, 94761, 94770 | Pulmonary stress testing; simple (eg, 6-minute walk test, prolonged exercise test for bronchospasm with pre- and post-spirometry and oximetry) | $105.96 |
ICD-9 Codes for Spirometry
The following ICD-9 Codes support the medical necessity for the use of a spirometer. They include, but are not limited to:
| 466 – 466.19 | Acute bronchitis and bronchiolitis |
| 490 | Bronchitis, not specified as acute or chronic |
| 491 – 491.9 | Chronic Bronchitis |
| 492 – 492.8 | Emphysema |
| 493 – 493.91 | Asthma |
| 494 | Bronchiectasis |
| 496 | Chronic airway obstruction, not elsewhere classified |
| 508 – 508.9 | Respiratory condition due to other and unspecified external agents |
| 518.9 | Other diseases of respiratory system, not elsewhere classified |
| 519.1 | Bronchospasm |
| 780.51 | Insomnia with sleep apnea |
| 786.2 | Cough |
| 780.53 | Hyperinsomnia with sleep apnea |
| 793.1 | Abnormal chest x-ray |
| 786 | Abnormal chest sounds |
| 277 | Cystic Fibrosis |
| 790.7 | Chronic fatigue |
| 787 | Heartburn |
| E942.9 | Other unspecified agents primarily affecting the cardiovascular system |
| 305.1 | History of tobacco abuse |
| V13.8 | History of thyroid disorder |