Saturday, April 24, 2010

CPT code 94660

94660 is the cpt code for CPAP initiation and management. This is a poorly understood code; there is always disagreement when someone asks about it at an American Academy of Sleep Medicine business seminar.

I used to bill this along with a level 3 (99213) evaluation and management code when I saw someone in the office, prescribed CPAP, and the patient's CPAP machine was set up on site. Usually on-site CPAP set up was done only for patients with Blue Cross/Blue Shield plans; it was done by a DME company that I had no ownership interest in.

I did find a mention of this code in an article in the American College of Chest Physicians. Although BC/BS payed for both codes (99213/94660) in Mississippi, apparently most insurers won't recognize both codes by the same provider on the same day: the 94660 code
is mutually exclusive of all E/M services during the same session by the same provider, according to the article (see the evaluation and management services section).

I do recommend that physicians not use the code 94660 with medicare/medicaid patients. If CPAP is being set up on site at your office (while the physician is present in the office complex), most insurers will not pay both codes at the same time. I do advise checking with the major insurers in your state to find out their policies for reimbursement of the 94660 code.


Mark said...

I recently learned of this code when I heard of a DME billing for it. Does this code require a physician or NP to see the patient face-to-face?

Michael Rack, MD said...

Mark, I don't think that 94660 requires face to face contact. I believe that the physician/np just needs to be physically present in the building when cpap is being set up, and needs to be available for questions/supervision of the person setting up the cpap machine.

Michael Rack, MD said...

thanks, 1202NathanV_woodell

Michael Rack, MD said...



will add a link to you site on my blogroll later today

Mark said...
This comment has been removed by the author.
Mark said...

Thanks Michael. I did speak with Trailblazer and they said a physician or NP needs to have face-to-face with the patient. I also found this (pdf) link:

I have also heard what you said, that they merely need to be in the building. How do I get a definitive answer on this? Thanks!

Michael Rack, MD said...

Mark, thanks for the link.

1. for f/u visits for patient already on cpap, I recommend billing an E and M code. If OSA is the only problem I am dealing with, I will usually bill a level 3 code.

2. If you are going to use this code on medicare patients, I recommend following their (Trailblazer's in your area) guidelines.

3. I don't think there is a nationwide definitive guideline.

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