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36.4 Procedures and Services
36.4.1 Aerosol Treatment
Aerosol treatments including vaporizers, humidifiers, nebulizers, and inhalers are appropriate methods of treatment for certain acute medical problems and should be coded 1-94640, 1-94644, 1-94645, and revenue code B-412.
Medication(s) used in the aerosol therapy may be considered for separate reimbursement when billed by the physician.
The outpatient facility should bill with revenue code B-412 for aerosol treatments.
Revenue code B-412 includes the following medications delivered by inhaler and is payable in the outpatient setting (POS 5) when it is the only therapy service billed on that day:
• Beclomethasone dipropionate.
•Isoproterenol sulfate.
•Isoproterenol hydrochloride.
•Albuterol.
•Metaproterenol sulfate.
•Epinephrine bitartrate.
•Phenylephrine bitartrate.
•Isoetharine mesylate inhalation aerosol.
•Dexamethasone sodium phosphate.
When revenue code B-412, Respiratory services-inhalation services, is billed on the same day for both aerosol therapy and inhalers, only one service is allowed, not both.
Revenue code B-412 may be reimbursed separately when billed for aerosol treatment in the recovery room after outpatient surgery (billed on an outpatient claim) as it is necessary adjunct to the postoperative recovery of a client who has undergone general anesthesia.
Pulse oximetry (5-94760 and 5-94761) is considered part of an E/M visit and will not be reimbursed separately.
Procedure Code 5-94664, demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device will not be reimbursed separately.
IPPB treatments have been determined to be inappropriate for the treatment of most respiratory problems and are denied.
Payment for professional services for aerosol therapy is limited to the following diagnosis codes:
Medications used in aerosol therapy, when billed by the physician, are reimbursed separately and should be billed using the appropriate HCPCS procedure code. A separate charge for saline used in aerosol therapy is denied as part of the aerosol therapy.
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