CSHCN 2009 > Certified Respiratory Care Practitioner (CRCP) > Benefits, Limitations, and Authorization Requirements

13.2 Benefits, Limitations, and Authorization Requirements

Services performed by CRCPs are a benefit if the client meets one of the following criteria:

•Has a respiratory or cardiorespiratory diagnosis requiring CRCP services

•Requires mechanical ventilation or depends on other medical technology to aid respiration

If a client meets the criteria listed above, the client may receive up to 30 visits for respiratory care services provided by a CRCP, per calendar year.

Services that are a benefit include, but are not limited to:

•CRCP services and treatments prescribed by a physician

•Educating the client or appropriate family members about the in-home respiratory care

Procedure codes 99503 and 99504 must be used when requesting prior authorization or billing for services. Procedure code 99503 is limited to once per day, per provider. Claims for CRCP services must include pertinent diagnosis codes.

Expendable supplies are not a benefit for CRCPs.

Refer to: Chapter 32, "Respiratory Equipment and Supplies" for more information about obtaining supplies.