Blue Cross, BCN will no longer separately pay providers for services performed by respiratory therapist, starting March 1

Effective March 1, 2025, Blue Cross Blue Shield of Michigan and Blue Care Network will no longer separately pay providers for services performed by a respiratory therapist on inpatient facility claims.

This payment policy isn’t intended to affect decision-making for care of the patient, and providers are expected to apply independent medical judgment when caring for all members. This policy applies to all inpatient facility claims submitted for Blue Cross and BCN commercial members.

Background

Respiratory therapy services are prescribed by a physician or nonphysician practitioner for the assessment and diagnostic evaluation, treatment, management and monitoring of patients with deficiencies and abnormalities of cardiopulmonary function. This policy pertains to services performed by a respiratory therapist in all prescribed settings (for example, an emergency room; regular room and board; an intensive care unit; or operating room). 

Respiratory therapy services aren’t separately payable on the inpatient facility claim, as they are inclusive to the respiratory modality, room and board, treatment area or laboratory.  

The following list provides examples of respiratory therapy services that aren’t separately payable on the inpatient facility claim. This isn’t an all-inclusive list.

• Arterial line blood draw
• Assisting with bedside procedures
• Patient and family education
• Respiratory assessments
• Suctioning
• Tracheostomy care and changing of cannula
• Transport of patient
• Venous and capillary blood draw
• Arterial puncture when the patient is on a ventilator
• Monitoring (pulse oximeters, arterial lines or readings, transcutaneous monitoring, end-tidal CO2 monitoring) when an intermediate ICU or ICU room and board charge is billed on the same date
• Administration of nebulizers or inhalers when billed on the same date of service as a charge for a CPAP, BiPAP, noninvasive ventilator or ventilator
• Chest physiotherapy (for example, percussion, vibration, postural drainage or cough assist) when billed on the same date of service as a charge for a CPAP, BiPAP, noninvasive ventilator or ventilator
• Therapeutic ventilatory maneuver (recruitment maneuver) when billed on the same date of service as a charge for a CPAP, BiPAP, noninvasive ventilator or ventilator