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Inhalation Treatment CPT 94640 – Billing Errors
The National Government Services Appeals Department has identified billing errors relevant to CPT code 94640 for inhalation treatment. When you bill more than one unit per episode of care, the line will deny with 54MUE.
Only report CPT code 94640 once during an episode of care regardless of the number of separate inhalation treatments administered. An episode of care begins when a beneficiary arrives at a facility for treatment and terminates when the beneficiary leaves the facility. If the episode of care lasts more than one calendar day, you should report only one unit of service of CPT code 94640 for the entire episode of care.
Edit 54MUE states that the units of service are in excess of the medically reasonable daily allowance frequency. You may not bill the beneficiary for excess charges due to the units of service greater than the maximum allowed. This provision cannot be waived and an ABN should not be issued.
Per the MUE files on the CMS website, CPT code 94640 is assigned an MAI of three meaning that the MUE for CPT code 94640 is a per day edit based on clinical benchmarks.
Related Content
- Medically Unlikely Edits – Be sure you use the correct file for the provider type and date of service
- NCCI Policy Manual for Medicare – learn more about MUEs and what the MAI indicators mean; of special note:
- Chapter 1, Section V - Medically Unlikely Edits (MUEs) defines MAIs
- Chapter 11, Section J.- Pulmonary Services includes discussion of CPT code 94640
Posted 7/26/2022