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December 2016 Texas Medicaid Provider Procedures Manual

Inpatient and Outpatient Hospital Services Handbook : 4 Outpatient Hospital (Medical and Surgical Acute Care Outpatient Facility) : 4.2 Services, Benefits, Limitations, and Prior Authorization : 4.2.20 Respiratory Services : * Pulmonary Function Studies
Pulmonary function studies considered for reimbursement to outpatient hospitals include, but are not limited to, the following procedures when submitted with the total component (TOS 5):
High Altitude Simulation Test (HAST) procedure codes 94452 and 94453 must be submitted with one of the following diagnosis codes:
When billing for HAST (procedure code 94452 or 94453) with one of the diagnosis codes indicated in the table with an asterisk (*), evidence of hypoxemia must be documented in the client’s medical record.
When multiple procedure codes are submitted, the most inclusive code of the related codes will be reimbursed and all other related codes will be denied.
When unrelated pulmonary function studies are submitted together, each will be considered for reimbursement.

Texas Medicaid & Healthcare Partnership
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