Question:

When is code 54250 is non-payable?

Answer:

Code 54250 is not listed in NCCI edits as non-payable when billed with codes for sleep studies (95805–95807). However, code 54250 is listed in NCCI edits as non-payable when billed with the codes for PSGs (95782, 95783, 95808, 95810, and 95811). The edits do not allow the use of a modifier with 54250 to justify separate payment.

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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