Respiratory Therapy — Breathing Treatments, Properly Coded

Proven Results

• 29.5% Average Revenue Increase
• 96.2% First-Pass Claim Rate
• 43.5% Reduction in Denials
• 14.8 Days Faster Payment Collection

Common Billing Challenges

Complex DME Coordination

Respiratory equipment billing requires coordination between therapy services and DME suppliers with separate coding requirements.

Documentation Requirements

Medicare and insurance companies require extensive clinical documentation for oxygen therapy, ventilators, and pulmonary rehabilitation.

Monthly Rental Billing Complexity

Oxygen concentrators and ventilators require accurate monthly rental billing with proper tracking of capped rental periods.

Certificate of Medical Necessity

CMN forms are mandatory for many respiratory equipment items and must be completed accurately with physician signatures.

Pulmonary Rehab Billing

Pulmonary rehabilitation programs have specific session limits and require careful tracking of visit frequency and medical necessity.

Home Care vs Facility Billing

Different billing rules apply for respiratory services provided in home settings versus facility-based care.

Our Solutions

Respiratory Therapy Billing Specialists

Our team includes certified coders with specialized training in respiratory care procedures, DME billing, and pulmonary rehabilitation.

• Expert HCPCS coding for respiratory equipment
• Proper CPT coding for therapy procedures
• Knowledge of capped rental billing rules
• Expertise in pulmonary rehabilitation coding

CMN & Documentation Management

Dedicated support for Certificate of Medical Necessity completion, clinical documentation, and medical necessity validation.

• CMN form completion and tracking
• Clinical documentation review
• Medical necessity validation
• Audit-ready documentation standards

Respiratory Equipment & Treatment Revenue

Coordinate billing across CPAP/BiPAP equipment rentals, oxygen therapy, pulmonary rehab sessions, and ventilator management services.

• CPAP and BiPAP rental-to-purchase conversion tracking with proper HCPCS codes
• Oxygen therapy CMN renewal scheduling to prevent coverage gaps
• Pulmonary rehabilitation session counting against Medicare's 36-session cap
• Ventilator management billing with proper E-code and supply modifiers

Compliance & Authorization Management

Comprehensive prior authorization handling and ongoing compliance monitoring for respiratory therapy services.

• Prior authorization management
• Frequency limit tracking
• Place of service verification
• Payer-specific requirement compliance

Specialized Services

Oxygen Therapy Billing

Expert billing for oxygen concentrators, liquid oxygen systems, and portable oxygen devices with proper rental tracking.

• Oxygen equipment rentals
• CMN documentation
• Monthly billing cycles
• Capped rental management

Mechanical Ventilation

Specialized billing for home ventilators, BiPAP, CPAP devices, and related respiratory support equipment.

• Ventilator rentals
• BiPAP/CPAP billing
• Supply coordination
• Maintenance billing

Pulmonary Rehabilitation

Comprehensive billing for structured pulmonary rehab programs with exercise training and patient education.

• Session-based billing
• Frequency tracking
• Outcome documentation
• Multi-disciplinary coordination

Respiratory Treatments

Accurate billing for nebulizer treatments, breathing exercises, and airway clearance therapy procedures.

• Treatment procedures
• Nebulizer billing
• Airway clearance
• Therapeutic interventions

Common CPT Codes Reference

Key codes include 94002 (Ventilation assist and management, hospital inpatient — init), 94003 (Ventilation assist and management — subsequent days), 94005 (Home ventilator management — physician or other QHP oversigh), 94010 (Spirometry, including graphic record, total and timed vital ), 94060 (Bronchodilation responsiveness, spirometry before and after ), 94070 (Bronchospasm provocation evaluation), 94150 (Vital capacity, total (separate procedure)), 94640 (Pressurized or non-pressurized inhalation treatment), 94644 (Continuous inhalation treatment with aerosol medication — fi), 94645 (Continuous inhalation treatment — each additional hour). Proper code selection requires understanding of bundling rules, NCCI edits, and modifier usage.

Expert Billing Insights

Ventilator Management Billing in Inpatient Settings

Respiratory therapy ventilator management in hospital settings is primarily billed by physicians and NPPs, not by RTs directly as a separate professional service. However, hospital outpatient and home health settings create different billing opportunities. RTs employed by hospitals contribute to global facility billing, while independent respiratory therapists and home health agencies use specific CPT and HCPCS codes. Understanding the billing entity structure is critical.

• Hospital-employed RTs: services fold into facility DRG/APG payment — no separate RT billing
• Independent RT practices and home health: bill with 94002/94003/94005 under physician supervision
• Home ventilator patients: monthly management codes with separate DME billing for equipment
• Document RCP (respiratory care plan) with physician signature for home vent management

Pulmonary Function Testing (PFT) Billing and Bundling Rules

PFT billing involves multiple component codes that are frequently bundled by payers. Spirometry (94010) and bronchodilator responsiveness testing (94060) are commonly performed together. Many payers use NCCI edits to prevent separate billing of component tests included in a comprehensive PFT panel. Correctly selecting which codes to bill — and which to bundle — requires knowledge of both AMA CPT guidelines and payer-specific NCCI edits.

• 94010 + 94060 are frequently billed together for pre/post bronchodilator evaluation
• Comprehensive PFT panels may include 94010, 94060, 94070, 94150, 94726 — verify payer bundling rules
• Flow-volume loops, diffusion capacity (94726), and body plethysmography (94726) have separate codes
• NCCI edits restrict same-day billing of certain PFT component codes

Home Oxygen and CPAP/BiPAP DME Coordination

Respiratory therapists frequently coordinate home oxygen therapy and positive airway pressure (PAP) device prescriptions. The medical equipment itself is billed under DMEPOS using HCPCS codes (E0601 for CPAP, E0470/E0471 for BiPAP), while therapy services related to patient education and compliance are separately billable. Sleep diagnostic data downloads for CPAP compliance tracking (99091) may be billed by overseeing physicians.

• CPAP: E0601; BiPAP (non-ventilatory): E0470; BiPAP (with backup rate): E0471
• Home oxygen certification requires physician signature on CMS-484 form
• CPAP compliance download interpretation: 99091 (physician data analysis)
• ABN required when home oxygen or PAP device documentation does not meet LCD criteria

Payer-Specific Billing Tips

Medicare Part B

• Medicare covers home oxygen under DMEPOS — requires Certificate of Medical Necessity (CMN)
• CPAP coverage requires documented AHI ≥15 or AHI ≥5 with symptoms — per LCD L33718
• Oxygen saturation testing (94760) is rarely reimbursed standalone — pair with clinical evaluation
• PFT interpretation by physician is billed separately from technical component

Medicaid

• Medicaid DME coverage for respiratory equipment varies widely by state
• Home ventilator coverage may require periodic recertification and physician attestation
• Some state Medicaid plans require prior authorization for PFTs beyond basic spirometry
• Pediatric home vent patients may have different Medicaid waiver coverage than adults

Commercial Payers

• Commercial plans typically cover PFTs for asthma, COPD, and occupational lung disease evaluations
• CPAP coverage usually requires a sleep study (PSG or HST) and documented AHI threshold
• Some commercial plans require a 90-day CPAP compliance download before covering ongoing supplies
• Bronchospasm provocation (94070) often requires prior authorization

Hospital Facility Billing

• Inpatient RT services are included in the DRG payment — no separate RT professional fee
• Outpatient RT services in hospital-based settings use APC (Ambulatory Payment Classification) rates
• RT services in skilled nursing facilities are part of PDPM consolidated billing
• Document all RT interventions in the medical record to support facility DRG severity

Key Services

• respiratory therapy billing
• RT billing services
• breathing treatment billing
• pulmonary rehabilitation billing