Facilities required to prorate respiratory therapy services

Blue Cross Blue Shield of Michigan and Blue Care Network will require facilities to prorate daily respiratory therapy services by hours used, not to exceed 24 hours in a single day. This billing rule is effective Jan. 1, 2021, for Blue Cross commercial, Medicare Plus Blue℠, BCN commercial and BCN Advantage℠ members. It applies to an inpatient setting only.

The following is a list of general respiratory therapy services applicable to this billing policy:

• All types of ventilators
• Continuous positive airway pressure, or CPAP
• Bilevel positive airway pressure, or BiPAP
• All types of oxygen

Billing example

On a single day of service, a patient is on the ventilator for five hours and then weaned to CPAP for the remaining 19 hours of the day. Previously, services were billed at a daily rate, regardless of hours used. New billing should reflect only those hours used for each modality.

Background

Respiratory therapy services are prescribed by a physician or non-physician practitioner for the assessment and diagnostic evaluation, treatment, management and monitoring of patients with deficiencies and abnormalities of cardiopulmonary function. This billing policy isn’t intended to affect physician decision-making; providers are expected to apply medical judgment when caring for all members.