Specimen collection can be an important part of performing respiratory therapy services. Which codes represent specimen collection services? There are several distinct codes for reporting these services. These include 36415, 36591, 36592, 36600, and 89220. Let’s review the fundamentals of each service to build success this year and beyond.
The first worth noting is Venipuncture. You can report the level I code 36415 to all payers including Medicare. Note that Medicare will reimburse for the venipuncture procedure once per encounter. One important factor to be aware of is to be sure to differentiate between venipuncture, capillary collection and draws from a line or access device. When collecting capillary specimens (36416), the related cost is considered by Medicare to be insignificant and should be bundled to the test procedure. For 2022, 36416 has again been assigned to status indicator “N,” meaning it is always packaged, and 36415 has been assigned to status indicator “Q4,” which means it will be conditionally packaged if billed on the same claim as a HCPCS code assigned a published status indicator “J1,” “J2,” “S,” “T,” “V,” “Q1,” “Q2,” or “Q3.” Understand that in other circumstances, payment will be made under the Clinical Laboratory Fee Schedule (CLFS). Do recognize that blood specimen collection performed during an IV start is not separately billable.
• For Venous Access Device (VAD), understand that code 36591 (collection of a blood specimen from a completely implantable VAD) can only be utilized when the VAD blood draw is from a completely implanted device, such as a Porta-Cath or Mediport. CPT® 36591 is designated as having a status indicator of “Q1.” A “Q1” is an “STV-packaged procedure.” Note that a procedure that has this designation may be separately reported to Medicare, but separate payment will be received only if no other status indicator “S,” “T,” or “V,” APC reimbursed procedure is billed on the same claim.
Know that CPT code 36592 should be assigned for blood draw from a PICC line or Hickman catheter. For 2022, code 36592 has been assigned to the same APC and status indicator as 36591. As stated above, the payment strategy referred to as “STV-packaged” codes means that conditions exist under which separate payment will be made, but when those conditions are not met, the payment will be packaged.
The codes assigned to a “Q1” status indicator will be paid separately when appearing on a claim without an “S,” “T,” or “V” procedure. Great concern exists by hospitals that question whether CPT codes 36591 and 36592 would ever be paid as their use is for the collection of blood specimens for laboratory testing. The AMA provided clarity by including a parenthetical note following each of these codes limiting their use with other laboratory services only.
When billing for arterial puncture specimen collection, report 36600. This CPT code holds a status indicator of “Q1” under the OPPS payment guidelines, meaning that, like the venous access device codes above, it will be paid separately when appearing on a claim without an “S,” “T,” or “V” procedure or separately through APC 5734. Note that this code is for the actual puncture of the artery; line draws are part of the continuum of care and not separately billable. The revenue center for blood specimen collection procedures should be 0300 unless instructed otherwise by the Part A/B MAC.
What about when it comes to sputum for diagnostic testing? Code 89220 is a covered service. The revenue code should be 0300, 0309, 0410, or 0419.
With the increase in “rapid screening tests” for respiratory syncytial virus (RSV) and influenza, MedLearn consultants have been receiving requests to provide CPT and billing instruction for collection of specimens via nasal lavage and suction. Unfortunately, there is no CPT or HCPCS code that represents the collection of this specimen. The cost is bundled into the cost of CPT codes 87631–87633.
Explore more billing tips and insight for respiratory CPT coding by ordering our Coding Essentials for RT/Pulmonary Function resource.
Grab your pens, alert your billing teams, and cue up your electronic medical record (EMR) vendors, because the Centers for Medicare & Medicaid Services (CMS)
Gilead Sciences, Inc. has agreed to pay $202 million to settle allegations raised by whistleblower Dr. Paul Bellman that Gilead violated the False Claims Act
Please log in to your account to comment on this article.
Stop revenue leakage and boost hospital performance by mastering risk adjustment and HCCs. This essential webcast with expert Cheryl Ericson, RN, MS, CCDS, CDIP, will reveal how inaccurate patient acuity documentation leads to lost reimbursements through penalties from poor quality scores. Learn the critical differences between HCCs and traditional CCs/MCCs, adapt your CDI workflows, and ensure accurate payments in Medicare Advantage and value-based care models. Perfect for HIM leaders, coders, and CDI professionals. Don’t miss this chance to protect your hospital’s revenue and reputation!
Struggling with ICD-10-CM coding for diabetes and complications? This expert-led webcast clarifies complex combination codes, documentation gaps, and sequencing rules to reduce denials and ensure compliance. Dr. Angela Comfort will provide actionable strategies to accurately link diabetes to complications, improve provider documentation, and optimize reimbursement—helping coders, CDI specialists, and HIM leaders minimize audit risks and strengthen revenue integrity. Don’t miss this chance to master diabetes coding with real-world case studies, key takeaways, and live Q&A!
Uncover critical guidance. HIM coding expert, Kay Piper, RHIA, CDIP, CCS, provides an interactive review on important information in each of the AHA’s 2025 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s fourth quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Stay ahead of Medicare Advantage’s 2025-2026 regulatory changes in this critical webcast featuring expert Tiffany Ferguson, LMSW, CMAC, ACM. Learn how new CMS rules limit MA plan denials, protect hospitals from retroactive claim reopenings, and modify Two-Midnight Rule enforcement—plus key insights on omitted SDoH mandates and heightened readmission scrutiny. Discover actionable strategies to safeguard revenue, ensure compliance, and adapt to evolving health equity priorities before the June 2025 deadline. Essential for hospitals, revenue cycle teams, and compliance professionals navigating MA’s shifting landscape.
Struggling with CMS’s 3-Day Payment Window? Join compliance expert Michael G. Calahan, PA, MBA, CCO, to master billing restrictions for pre-admission and inter-facility services. Learn how to avoid audit risks, optimize revenue cycle workflows, and ensure compliance across departments. Critical for C-suite leaders, providers, coders, revenue cycle teams, and compliance teams—this webcast delivers actionable strategies to protect reimbursements and meet federal regulations.
Providers face increasing Medicare audits when using skin substitute grafts, leaving many unprepared for claim denials and financial liabilities. Join veteran healthcare attorney Andrew B. Wachler, Esq., in this essential webcast and master the Medicare audit process, learn best practices for compliant billing and documentation, and mitigate fraud and abuse risks. With actionable insights and a live Q&A session, you’ll gain the tools to defend your practice and ensure compliance in this rapidly evolving landscape.
Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.
Copyright © 2025 RACmonitor. Powered by MedLearn Media.
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
