Question:

How does Medicare reimburse ventilation management provided during an observation stay?

Answer:

The service will be paid according to the guidelines for outpatient procedures. Under the outpatient procedure payment system (OPPS), the following procedure codes are paid according to APC 5801:

94002 Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day
94003 hospital inpatient/observation, each subsequent day

It should be noted that both CPT® codes map to an APC status indicator of “Q3,” meaning that if all criteria are met to trigger the Observation Comprehensive APC packaging rule (J2) ventilation management will be packaged to the observation stay.


CPT® is a registered trademark of the American Medical Association.

This question was answered in the 2018 edition of our Coding Essentials for RT/Pulmonary Function. For more hot topics relating to respiratory therapy services, please view our store, or call us at 1.800.252.1578 ext. 2.

 

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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.