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25.3.3.7 Pulmonary Function Studies
Pulmonary function studies include, but are not limited to, the following procedures:
When multiple procedure codes are billed, the most inclusive code of the related codes will be paid and all other related codes will be denied.
When procedure code 5/I/T-94010 is billed with procedure code 5/I/T-94200, 5/I/T-94010 will be denied as part of 5/I/T-94200.
When procedure code 5/I/T-94010 is billed with 5/I/T-94060, 5/I/T-94010 will be denied as part of 5/I/T-94060.
When procedure code 5/I/T-94150 is billed with 5/I/T-94240, procedure code 5/I/T-94150 will be denied as part of 5/I/T-94240.
When procedure code 5/I/T-94200 is billed with 5/I/T-94060, procedure code 5/I/T-94200 will be denied as part of 5/I/T-94060.
When procedure codes 5/I/T-94010, 5/I/T-94200, and 5/I/T-94060 are billed with procedure code 5/I/T-94070, procedure codes 5/I/T-94010, 5/I/T-94200, and 5/I/T-94060 will be denied as part of 5/I/T-94070.
When procedure codes 5-94014 and 5-94015 are billed together, procedure code 5-94015 will be denied as part of 5-94014.
When procedure codes 5-94014, 5-94015, and 5-94016 are billed more than once per month they will suspend for review.
When procedure code 5/I/T-94621 is billed more than once per day by the same provider, the claim will suspend for review.
When unrelated pulmonary function studies are billed together, each will be paid.
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