getting paid, hospital, CPT, code 94762, CPT codes, APC 0443, Procedure codes categorized as Q, OPPS procedure, Coding, Paid
Our hospital has trouble getting paid for code 94762. Can we provide any guidelines on why this may be occurring since we have met the medical necessity requirements?
July 20, 2009
In the 2007 hospital outpatient prospective payment system (OPPS) final rule, the Centers for Medicare & Medicaid Services (CMS) introduced the new status indicator of Q, which categorizes a select group of CPT codes as "special packaged items," and code 94762 (pulse oximetry; continuous overnight determination) is one of those codes.
Procedure codes categorized as Q will be reimbursed according to APC assignment when they appear on a claim with no other separately payable OPPS procedure. When medical necessity has been met for performance of overnight continuous pulse oximetry as an outpatient procedure and when no other OPPS service is performed on the same date of service, the procedure will be paid according to APC 0443. If any other OPPS service is billed on the same date of service, 94762 will be packaged and not separately paid.