Ventilatory assistance is applicable to patients of all ages, as well as neonates who are on respirators.

Claims reporting only ventilatory assistance or respirator care should be processed under codes 94002-94004, 94660 and 94662. However, when critical care (codes 99291-99292), pediatric critical care (codes 99293-99294), pediatric critical care transport (codes 99289-99290), neonatal critical care (codes 99295-99296), or subsequent intensive care (codes 99298-99300 and 99477) and ventilatory assistance are reported on the same day by the same doctor, the charges for the ventilatory assistance should be denied, with payment being made for the critical care or neonatal intensive care, only. A participating, preferred, or network provider may not bill the patient separately for the ventilatory assistance. Modifier 59 may be reported with a non-E/M service, to identify it as distinct or independent from other non-E/M services performed on the same day.  When modifier 59 is reported, the patient’s records must support its use in accordance with CPT guidelines.

Description

Ventilatory assistance is a form of critical care not to be distinguished from other forms of prolonged detention or critical care for other conditions.

This medical policy may not apply to FEP.  Medical policy is not an authorization, certification, explanation of benefits, or a contract.  Benefits are determined by the Federal Employee Program.