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Coverage & Reimbursement

The Pinnacle Healthgroup

Circassia’s Reimbursement Partner

Providing coding & reimbursement support for NIOX®

  • Hotline team of certified coders here to support Circassia’s customers
  • Can answer any questions related to coding, including:
    • FeNO coverage – generic and specific payers
    • Support providers with the appeal process
    • Updates to clinical policy for FeNO monitoring

Contact Information

Available live Monday-Friday, 8:30AM-6PM ET
Call 1-866-369-9290
Email at circassia@thepinnaclehealthgroup.com

FeNO Monitoring CPT/HCPCS Codes

Below is a sample of the coding reference guide for healthcare providers billing for FeNO monitoring and related services. For the full coding reference guide, please click FeNO CPT Coding Reference Guide on the right to download the PDF.

CPT/HCPCS Code1
Descriptor
95012
Nitric oxide expired gas determination
A4617
Mouthpiece
99201-99205*
New patient office visit for the evaluation and management
99211-99215*
Established patient office visit for the evaluation and management

*Use of these codes requires the appropriate use of modifiers. If an E&M code is reported with CPT 95012, the 25 modifier must be appended.

DISCLAIMER: Procedure coding should be based upon medical necessity and services, procedures and supplies provided to the patient. Coding and reimbursement information is provided for educational purposes and does not guarantee coverage of the specific item or service in a given case. It is not intended to maximize reimbursement by any payer. Circassia and The Pinnacle Health Group make no guarantee of coverage or reimbursement of fees. Contact your local Medicare Administrative Contractor (MAC) or CMS for specific information as payment rates listed are subject to change and will vary by payer and region. To the extent that you submit cost information to Medicare, Medicaid or any other reimbursement program to support claims for services or items, you are obligated to accurately report the actual price paid for such items, including any subsequent adjustments. Circassia disclaims any responsibility for claims submitted by providers. It is the provider’s responsibility to determine appropriate codes, charges, and modifiers, and to submit bills for services and products consistent with what was rendered as well as the patient’s insurer requirements. CPT® is a registered trademark of the American Medical Association.

Reference: 1. January 2007 Nonoutpatient prosecptive payment system (non-OPPS) outpatient code editor (OCE) specifications version 22.1. Centers for Medicare and Medicaid Services. Published January 1, 2007. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1150CP.pdf. Accessed August 20, 2018.

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