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94005
Quick jump to procedure code: Printer Friendly Version
94011

CPT® 94010: SPIROMETRY, INCLUDING GRAPHIC RECORD, TOTAL AND TIMED VITAL CAPACITY, EXPIRATORY FLOW RATE MEASUREMENT(S), WITH OR WITHOUT MAXIMAL VOLUNTARY VENTILATION

Short Description: Breathing capacity test

--

CPT copyright 2015 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Marin/Napa/Solano
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Rest of North California
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-Rest of South California
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
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OREGON-Rest of Oregon
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PENNSYLVANIA-Rest of Pennsylvania
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TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
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VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State

2016 Physician
Fee Schedule:

Global Fee $ 36.19
26 Modifier $ 8.60
TC Modifier $ 27.59

2016 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2016 Unadjusted OPPS Payment $129.75


*Based on National 2013 Medicare Part B submitted claims.
2016 APC Code: 5721
Level1 Diagnostic Tests and Related Services

2016 OPPS Status Indicator: Q1

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
PercentageICD-9ICD-10 Conversions
9.7% 496    Chronic airway obstruction, not elsewhere classified J44.9   Chronic obstructive pulmonary disease, unspecified
9.4% 786.05    Shortness of breath R06.02   Shortness of breath
6.0% 786.09    Other respiratory abnormality R06.00   Dyspnea, unspecified
OR:
R06.09   Other forms of dyspnea
OR:
R06.3   Periodic breathing
OR:
R06.83   Snoring
OR:
R06.89   Other abnormalities of breathing
4.8% 786.2    Cough R05   Cough
4.5% 493.90    Asthma, unspecified, unspecified J45.909   Unspecified asthma, uncomplicated
OR:
J45.998   Other asthma
2.2% 493.00    Extrinsic asthma, unspecified J45.20   Mild intermittent asthma, uncomplicated
1.9% V04.81    Need for prophylactic vaccination and inoculation, Influenza Z23   Encounter for immunization
1.7% 477.9    Allergic rhinitis cause unspecified J30.0   Vasomotor rhinitis
OR:
J30.9   Allergic rhinitis, unspecified
1.5% 491.20    Obstructive chronic bronchitis without exacerbation J44.9   Chronic obstructive pulmonary disease, unspecified
1.5% 518.89    Other diseases of lung, not elsewhere classified J98.4   Other disorders of lung

* Commonly Associated ICD-10 codes derived from 2010 Physician Supplier Part B Medicare claims data and 2015 CMS General Equivalency Mapping Codes (GEM).
This data represents an analysis of 43 million claims processed for 1.7 million beneficiaries in 2010.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

94010 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 94010

CCI and MUE Edits*         Hide this section.

CCI Edits for 94010
Denied Codes (1)
Effective
Modifier
Accepted (2)
00520 Anesth chest procedure
07/01/2002 No
36591 Draw blood off venous device
10/01/2015 No
36592 Collect blood from picc
10/01/2015 No
94150 Vital capacity test
01/01/2012 Yes
94200 Lung function test (mbc/mvv)
01/01/1996 Yes
94375 Respiratory flow volume loop
01/01/1996 No
94728 Pulm funct test oscillometry
01/01/2012 No
95070 Bronchial allergy tests
01/01/1996 Yes
95071 Bronchial allergy tests
01/01/1996 Yes
99201 Office/outpatient visit new
01/01/2014 Yes
99202 Office/outpatient visit new
01/01/2014 Yes
99203 Office/outpatient visit new
01/01/2014 Yes
99204 Office/outpatient visit new
01/01/2014 Yes
99205 Office/outpatient visit new
01/01/2014 Yes
99211 Office/outpatient visit est
01/01/2014 Yes
99212 Office/outpatient visit est
01/01/2014 Yes
99213 Office/outpatient visit est
01/01/2014 Yes
99214 Office/outpatient visit est
01/01/2014 Yes
99215 Office/outpatient visit est
01/01/2014 Yes
99281 Emergency dept visit
01/01/2014 Yes
99282 Emergency dept visit
01/01/2014 Yes
99283 Emergency dept visit
01/01/2014 Yes
99284 Emergency dept visit
01/01/2014 Yes
99285 Emergency dept visit
01/01/2014 Yes
99304 Nursing facility care init
01/01/2014 Yes
99305 Nursing facility care init
01/01/2014 Yes
99306 Nursing facility care init
01/01/2014 Yes
99307 Nursing fac care subseq
01/01/2014 Yes
99308 Nursing fac care subseq
01/01/2014 Yes
99309 Nursing fac care subseq
01/01/2014 Yes
99310 Nursing fac care subseq
01/01/2014 Yes
99315 Nursing fac discharge day
01/01/2014 Yes
99316 Nursing fac discharge day
01/01/2014 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
99318 Annual nursing fac assessmnt
01/01/2014 Yes
99324 Domicil/r-home visit new pat
01/01/2014 Yes
99325 Domicil/r-home visit new pat
01/01/2014 Yes
99326 Domicil/r-home visit new pat
01/01/2014 Yes
99327 Domicil/r-home visit new pat
01/01/2014 Yes
99328 Domicil/r-home visit new pat
01/01/2014 Yes
99334 Domicil/r-home visit est pat
01/01/2014 Yes
99335 Domicil/r-home visit est pat
01/01/2014 Yes
99336 Domicil/r-home visit est pat
01/01/2014 Yes
99337 Domicil/r-home visit est pat
01/01/2014 Yes
99341 Home visit new patient
01/01/2014 Yes
99342 Home visit new patient
01/01/2014 Yes
99343 Home visit new patient
01/01/2014 Yes
99344 Home visit new patient
01/01/2014 Yes
99345 Home visit new patient
01/01/2014 Yes
99347 Home visit est patient
01/01/2014 Yes
99348 Home visit est patient
01/01/2014 Yes
99349 Home visit est patient
01/01/2014 Yes
99350 Home visit est patient
01/01/2014 Yes
99497 Advncd care plan 30 min
01/01/2016 Yes
G0463 Hospital outpt clinic visit
07/01/2014 Yes
94011 Spirometry up to 2 yrs old
07/01/2011 Yes
94012 Spirmtry w/brnchdil inf-2 yr
01/01/2010 No
94014 Patient recorded spirometry
06/05/2000 Yes
94015 Patient recorded spirometry
07/01/2001 Yes
94060 Evaluation of wheezing
01/01/1996 No
94070 Evaluation of wheezing
01/01/1996 Yes
94620 Pulmonary stress test/simple
01/01/1996 Yes
94621 Pulm stress test/complex
06/05/2000 Yes
G0237 Therapeutic procd strg endur
10/01/2010 Yes
G0238 Oth resp proc, indiv
10/01/2010 Yes
G0239 Oth resp proc, group
10/01/2010 Yes
G0424 Pulmonary rehab w exer
10/01/2010 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 94010.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


Medically Unlikely Edits for 94010


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical Not Listed
Rationale: Clinical: Data Clinical: Data Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.


   94010 Top 5 Ordering Providers National*
BRUCE MEHLMAN -FORT MYERS,FL 2,796
MOHAMMAD-ALI EL-HARAKEH -PRESCOTT,AZ 2,766
JASON KARP -LAKE SUCCESS,NY 2,702
NEIL MACINTYRE -DURHAM,NC 2,445
FRANCIS COLLINS -PINEHURST,NC 2,230

   94010 Top 5 Ordering Organizations National*
B & M OXIMETRY LAB, INC.-FL 2,170
WEST COAST DIAGNOSTICS LLC-CA 560
PROACTIVE MD, LLC-TN 486
WESTERN MARYLAND HEALTH SYSTEM CORPORATION-MD 246
INTEGRATED MANAGEMENT & DIAGNOSTIC SERVICES-CA 163

*Based on 2014 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 94010*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2014: 1,424,202
Total Services Denied 2014: 160,280 (11.3%)
National Charges Submitted 2014: $108,248,484.00
National Charges Allowed 2014: $ 38,896,224.00
National Average (No Modifier) Fee Submitted 2014: $ 83.35
National Average (No Modifier) Fee Allowed 2014: $ 36.32
National Average (26) Fee Submitted 2014: $ 47.54
National Average (26) Fee Allowed 2014: $ 8.57
National Average (QW) Fee Submitted 2014: $ 82.77
National Average (QW) Fee Allowed 2014: $ 0.00
National Average (TC) Fee Submitted 2014: $ 66.35
National Average (TC) Fee Allowed 2014: $ 27.23


Top 5 Performing Specialties 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Pulmonary disease 631,672 44.4% $ 74.34 53,903 8.5%
Internal medicine 293,821 20.6% $ 75.31 43,463 14.8%
Allergy/immunology 183,608 12.9% $ 80.91 17,461 9.5%
Family practice 143,106 10.0% $ 72.81 22,911 16.0%
Critical care
(intensivists)
(eff 5/92)
44,951 3.2% $ 71.01 5,124 11.4%

Top 5 Places of Service 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 1,171,443 82.3% $ 81.72 137,758 11.8%
Outpatient hospital 209,570 14.7% $ 48.29 17,461 8.3%
Inpatient hospital 31,996 2.2% $ 48.81 3,432 10.7%
Home 8,255 0.6% $ 77.81 792 9.6%
Urgent Care Facility (eff. 1/1/03) 1,340 0.1% $ 71.50 434 32.4%

Top 5 Modifiers Submitted 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 995,868 69.9% $ 83.35 117,703 11.8%
26 - Professional Component 268,824 18.9% $ 47.54 20,191 7.5%
59 - Distinct Procedural Service 119,876 8.4% $ 81.16 16,743 14.0%
TC - Technical Component 23,974 1.7% $ 66.36 1,886 7.9%
GA - Advanced Beneficiary Notice (ABN) on File 8,584 0.6% $ 62.41 1,572 18.3%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.



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06/28/2016 12:55:38 54.196.113.216

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