Billing and Coding: Pulmonary Rehabilitation Services - R5 - Effective May 19, 2022

This coverage article has been revised and published for notice under contract numbers: 02102 (AK), 02202 (ID), 02302 (OR), 02402 (WA), 03102 (AZ), 03202 (MT), 03302 (ND), 03402 (SD), 03502 (UT), and 03602 (WY).

Effective Date: May 19, 2022

Summary of Article Changes: In the Article Text under Sources, corrected the hyperlink to Transmittal 11426CP, CR 12613 dated May 20, 2022, and clarified the appropriate use of the KX modifier when billing for services related to 94625 and 94626 for both COPD and COVID-19.

In the HCPCS/CPT Codes Group1 Paragraph, clarified HCPCS codes G0237-G0239 are for outpatient respiratory services.

In the Group 1 Paragraph in the ICD-10-CM Codes That Support Medical Necessity added the statement “The diagnosis codes below are applicable only when performing pulmonary rehabilitation services billed with CPT® codes 94625 and 94626.”

In the Group 1 Asterisk Explanation portion in the ICD -10-CM Codes That Support Medical Necessity section added the statement “For diagnosis code U09.9 assign a code(s) for the specific symptom(s) or condition(s) related to the previous COVID-19 infection, if known.”

Added the following DX codes to the Group1 ICD-10-CM Codes That Support Medical Necessity:

  • J41.1 Mucopurulent chronic bronchitis
  • J41.8 Mixed simple and mucopurulent chronic bronchitis

Noted in the Revision History the diagnosis codes J40.0, J40.1 & J40.9 in Revision History #2 should be J44.0, J44.1 & J44.9.

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Last Updated Jun 16 , 2022