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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 9 Physician : 9.2 Services, Benefits, Limitations, and Prior Authorization : 9.2.67 Sleep Studies : 9.2.67.2 Pneumocardiograms

9.2.67.2
Pneumocardiograms (procedure code 95807) are limited to clients who are birth through 12 months of age.
Pneumocardiograms are limited to one per day, and two per rolling year by any provider. Claims denied for more than two times per year may be appealed with documentation of medical necessity.
Procedure code 95807 must be billed with one of the following diagnosis codes:
 
Documentation of the complete readings associated with the pneumocardiogram and the physician’s interpretation must be maintained in the client’s medical record in a hard-copy printout or electronic file at the facility where the procedure is performed.
The physician’s interpretation and report must include inspection and integration of the information gathered from all physiological systems and other professionals’ analysis and observations.

Texas Medicaid & Healthcare Partnership
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