How is ventilation management reimbursed when provided during an observation stay under OPPS guidelines?
When ventilation management is provided during an observation stay the service will be paid according to the guidelines for outpatient procedures. Under the OPPS, the procedure codes 94002 and 94003 are paid according to APC 5801. It should be noted that both CPT codes map to an APC status indicator of “Q3,” meaning that if all criteria are met to trigger the Observation Comprehensive APC packaging rule (“J2”) ventilation management will be packaged to the observation stay.
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