What is the CPT code for albuterol treatment?

Asked By: Tammera Hassany | Last Updated: 8th June, 2020
Category: medical health lung and respiratory health
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ANSWER: Typically, when a nurse administers a hand-held nebulizer that contains a drug such as Albuterol, the nurse is following a physician's order for inhalation treatment (CPT 94640, Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes).

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Accordingly, how do you bill albuterol treatment?

The O2Sat (94760) and inhalation treatment (94640) are separately billable, as is the nebulizer mask (A7003). The proper HCPCS Level II code for the medication is J7611 Albuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, concentrated form, 1 mg.

One may also ask, what does CPT code 94640 mean? CPT code 94640 describes treatment of acute airway obstruction with inhaled medication and/or the use of an inhalation treatment to induce sputum for diagnostic purposes.

One may also ask, how do you code a nebulizer treatment?

The code for the nebulizer treatment is, "94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB)

What is the ICD 10 code for albuterol?

Relevant medical records that support it is medically necessary to administer arformoterol (J7605), formoterol (J7606), albuterol (J7613), albuterol/ipratropium (J7620) or budesonide (J7626) for the management of obstructive pulmonary disease (ICD-10 diagnosis codes J41. 0 – J70.

29 Related Question Answers Found

How do you bill for multiple nebulizer treatments?

94640 twice (some carriers allow billing for multiple aerosol treatments without a modifier). Or, if the carrier follows NCCI, you may report 94060 only, and not 94640. (94760–59 twice, 94060–59, 94010–59, 94640–59 twice). This information provided by The Coding Institute.

What is procedure code 94060?

CPT code 94060 (bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration) describes a diagnostic test that is utilized to assess patient symptoms that might be related to reversible airway obstruction. CPT code 94060 includes the administration of a bronchodilator.

What is the NDC number for j7613?

ALBUTEROL INHALATION SOLUTION .083% 3ML 25/BX
Package AWP: $20.00
J-Code: J7613
Strength: 0.083%
Form: Solution
NDC Number: 00487950125 00487-9501-25

Does CPT code 94664 need a modifier?

Since the physician is indicating that an E/M service was significant and separate from a procedure or procedure(s) (94640 and 94664), the 25 modifier could be reported on the E/M service (99214). **Some carriers now require the 25 modifier on the E/M service when reporting a procedure from the code set 94010-94799.

How do you bill for a 6 minute walk test?

CPT code 94618 Pulmonary stress testing (eg, 6-minute walk test), including measurement of heart rate, oximetry, and oxygen titration, when performed, describes the typical simple pulmonary stress test.

How do you bill for breathing treatments?

If the treatment is less than 1 hour, you would bill Current Procedural Terminology (CPT) code 94640, “Pressurized or non-pressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose

Is pulmonary function test covered by Medicare?


Medical necessity is an overriding requirement for Medicare coverage of diagnostic testing. When a diagnosis or evaluation can be made clinically or when test results are not necessary to manage the patient's disease, then Pulmonary Function Testing is not reasonable and necessary.

How do you bill for spirometry?

The 94010 code de- scribes “spirometry” and is grouped in APC 0367. The flow-volume CPT code 94375 could also be used, but it is in the same Medicare APC 0367 and thus pays the same technical fee (professional fees may be different in some regions).

How do you bill a pulmonary function test?

Pulmonary Function Testing codes:
CPT codes relative to Medicare's standards of reasonable and necessary care are: 94070, 94200, 94640, 94726, 94727, 94729 and 94750. Spirometry - CPT codes for Spirometry include 94010, 94011, 94012, 94060, 94070, 94150, 94200, 94375, 94726 and 94727.

What is a modifier in CPT coding?

A modifier is a code that provides the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but has not changed in its definition or code.

Does Medicare cover peak flow meter?

Peak flow meters are covered for the self-monitoring of patients with pure asthma, (ICD-9 493.00-493.11) when they are used as part of a comprehensive asthma management program.

Is there a CPT code for asthma action plan?


What if your patient sees an Allergist who is not in TCCN? You can review the action plan with parents that they already have from their specialist and bill the 5250F CPT code. It would be best to include the asthma action plan in the patient's chart.

What is the correct CPT code for bronchoscopy with BAL?

CPT® tells us, “codes 31622-31646 include fluoroscopic guidance when performed.” This notation includes all but one of the codes in this endoscopy section, so practices should not bill separately for guidance, according to CPT®. The code for diagnostic bronchoscopy is 31622.

Does Medicare pay for albuterol?

Medicare does not pay for over-the-counter or most outpatient prescription drugs. However, Medicare Part B will cover drugs which are necessary for the effective use of durable medical equipment (DME). One such drug, albuterol, is commonly used with a nebulizer to treat patients suffering from asthma or emphysema.