According to an industry guide we use, Nitric oxide expired gas determination (95012), or the measurement of eNO, has not been assigned a physician work RVU. Therefore, this would be billable only in an outpatient setting, not in a facility. This code is slowly gaining acceptance as a diagnostic tool in allergist practices.
Medicare has the code listed as a payable code, but many other payers may not recognize it as a payable code. The 95012 code is used when determining the NO expired gas determination. A patient’s NO level is measured using specialized equipment and under the direct supervision of a clinician. The patient is instructed to exhale, place the testing device in the mouth and inhale to lung capacity. The clinician monitors the patient to ensure a steady compliance inhalation, and the patient’s NO level is determined by the device, which uses a chemiluminescence gas analyzer and integrated software to measure numbers of NO molecules at very low concentrations. The reimbursement for this code varies by payer. Some payers consider the eNO determination code to be experimental and, therefore, the patient to be responsible for the charge.
If a procedure or service for pulmonary function studies is not described in the CPT book under one of the listed codes, then the appropriate manner to code for the services would be to submit notes and use the unlisted procedure code 94799. Respiratory muscle strength measurements are reported correctly with 94799.
When billing health plans for use of the NIOX family of products, physicians should consider using CPT code 95012 – Nitric oxide expired gas determination.
Physicians should only bill CPT code 95012 if they actually perform the NIOX test in their offices. If the NIOX test is performed in a hospital or other free-standing facility, 95012 should not be used for physician interpretation and/or report on the test. Similarly, physicians should not bill an E&M visit only for test interpretation and/or report. If the NIOX test is performed as part of a significant, separately identifiable E&M office visit, providers should consider billing 95012 for the NIOX test and billing the most appropriate E&M visit type in conjunction with modifier -25 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service.