What are the billing requirements for 94625 and 94626?
In the hospital outpatient setting, payment for PR services will be set by establishing a clinical APC with a median “per session” cost, simulated from historical claims data for similar pulmonary therapy services. Physical therapists cannot bill PT codes separately if they conduct assessments and individual treatment services as part of a PR program. The PT services are now included as part of the overall treatment plan for PR and are to be billed using the new codes 94625–94626 for 2023.
This question was answered in our Coding Essentials for RT/Pulmonary Function. For more hot topics relating to respiratory services, please visit 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.
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