CurrentArizona Complete HealthPolicy CC.PP.025

Payment Policy: Pulse Oximetry with Evaluation & Management Services

Defines payment and bundling criteria for pulse oximetry (CPT 94760, 94761) billed on professional claims, specifically when billed with evaluation and management (E/M) services by the same provider on the same date.

Policy Summary

PayerArizona Complete Health

PolicyPulse Oximetry with Evaluation & Management Services

Policy CodePolicy CC.PP.025

Change TypeNo material change

Effective DateJan 1, 2014

Next Review Date

Key ActionDeny pulse oximetry (CPT 94760, 94761) when billed on the same date by the same provider with an E/M service and bundle it into the E/M service.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2CPT codes referenced (94760, 94761)

Same date / same providerBundling condition

Professional ClaimsApplies to

95-100%Normal SpO2

Status TCMS status cited

Coverage Criteria for Pulse Oximetry

Policy Summary

PayerArizona Complete Health

PolicyPulse Oximetry with Evaluation & Management Services

Policy CodePolicy CC.PP.025

Change TypeNo material change

Effective DateJan 1, 2014

Next Review Date

Key ActionDeny pulse oximetry (CPT 94760, 94761) when billed on the same date by the same provider with an E/M service and bundle it into the E/M service.

SourceLink

On This Page

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Pulse oximetry bundling criteria

Payment determinations for pulse oximetry when billed with evaluation and management (E/M):

If pulse oximetry (CPT 94760 or 94761) is billed on the same date by the same provider as an evaluation and management (E/M) service, the pulse oximetry will be denied and considered bundled into the E/M service.

Pulse oximetry represents a fundamental component of the assessment services provided during an office visit or procedure and is not separately reimbursable when billed with an E/M by the same provider on the same date.

CMS assigns CPT codes 94760 and 94761 status indicator 'T'; Status 'T' procedures are only payable if no other physician fee‑schedule services are paid on the same date by the same provider — otherwise they are bundled into the paid physician service.

Relevant CPT Codes and CMS Status

Pulse oximetry CPT codesCPT

94760	Noninvasive ear or pulse oximetry for oxygen saturation; single determination.
94761	Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations (e.g., during exercise).

CMS status indicator — CPT 94760, 94761

CMS status assignmentCPT codes 94760 and 94761 are assigned CMS status indicator 'T'

Payment condition for status 'T' codesStatus 'T' procedures are only payable if no other services payable under the physician fee schedule are billed on the same date by the same provider

Bundling outcomeIf any other physician-fee-schedule services are billed same date by the same provider, 94760 and 94761 are bundled into the other paid service and not separately paid

Provider Billing and Documentation Actions

Billing Rule

Do not bill pulse oximetry separately with E/M on same date by same provider

Pulse oximetry (CPT 94760, 94761) is denied and considered bundled when billed on the same date by the same provider with an evaluation and management (E/M) service; the pulse oximetry will be bundled into the E/M service and not separately reimbursed.

Applies when pulse oximetry is billed with an office visit or other E/M service on the same date by the same provider.
Rationale: pulse oximetry is considered a fundamental component of assessment services and not separately reimbursable when performed with E/M.

Definitions and CMS Status Explanation

Pulse oximetry — definition and measures

DefinitionPulse oximetry involves application of an electronic oximetry device to monitor oxygen bound to hemoglobin and may also read pulse rate; results reported as percentage saturation

Typical application sitesDevice typically attached to the finger or ear

Reported resultOxygen saturation reported as percentage of maximum hemoglobin oxygen binding capacity

Normal rangeNormal oxygen saturation level is between 95-100%

Status 'T' (CMS) — payment implications

Meaning of status 'T'CPT codes designated with status indicator 'T' are only payable if no other physician-fee-schedule services are paid on the same date by the same provider; otherwise they are bundled into the other paid service

RationaleCMS states many procedures require cardiopulmonary monitoring integral to the procedure and are not separately reportable

ApplicabilityApplies to services billed under the physician fee schedule on the same date by the same provider