Evaluation Management Services with Pulmonary Diagnostic Procedures

Date Issued: 7/30/2019

EmblemHealth has been implementing payment policies that reflect guidelines set forth by industry authorities. Our goal is to process claims consistently and in accordance with best practice standards. We will be instituting new payment policies for Evaluation and Management (E/M) Services with Pulmonary Diagnostic Procedures.

Reference:

According to the AMA CPT manual: Medicine/Pulmonary section, Pulmonary Diagnostic Testing and Therapies subsection. Codes 94010-94799 include laboratory procedure(s) and interpretation of test results. An E/M service (99201-99215, 99241-99245, 99281-99285, 99304-99318, 99324-99337, 99341-99350) will deny if billed with 94010-94799 unless it is a separately identifiable service from the interpretation of test results and appropriate modifiers are billed.