Pulse ox

I was told that pulse ox "94760 or 94761" should not be billed and that it is included with the E/M? I have been billing AR Medicaid using a mod of "59" PFT or not and have been getting paid for it. Now I am being told that it should have not paid at all.

re: Pulse ox

it is generally recognized as bundled by most insurers. But, you are reporting what services were provided to the patient and if they want to recognize it as a valid service and pay you, then it. This is not the same as unbundling where there are clear guidelines that you are violating. Feel free to send us all a little of the cash!

re: Pulse ox

Can "94760" and "94060" be billed together? Per Ar Medicaid, to not bill the code at all under any circumstances. If I am not breaking any rules, then I will continue to bill Medicaid as I would do to other carriers. Thank you.

re: Pulse ox

These two codes: 94760 and 94060 are not bundled together. However, 94760 is considered bundled by Medicare with any E/M services.

State Medicaids are allowed to make their own rules, so it's hard to comment on their individual reimbursement policies. You might look on their website for help.

re: Pulse ox

94760 is a billable/payable code per their fee schedule.