How To Use CPT Code 94005

CPT 94005 describes the oversight and revision of a patient’s home ventilator management care plan by a healthcare provider. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 94005?

CPT 94005 can be used to describe the oversight and revision of a patient’s home ventilator management care plan by a healthcare provider. This code is used when the provider spends 30 minutes or more reviewing the patient’s status, laboratory values, and other studies, and revising orders and the respiratory care plan as necessary.

2. Official Description

The official description of CPT code 94005 is: ‘Home ventilator management care plan oversight of a patient (patient not present) in home, domiciliary or rest home (eg, assisted living) requiring review of status, review of laboratories and other studies and revision of orders and respiratory care plan (as appropriate), within a calendar month, 30 minutes or more.’

3. Procedure

1. The healthcare provider reviews the patient’s clinical status, laboratory values, and results of other studies.
2. Based on the assessment, the provider revises the patient’s orders and respiratory care plan to improve their health and respiratory status.
3. This service is performed in the patient’s home or assisted living facility without the patient present.
4. The provider spends 30 minutes or more on this oversight and revision process.

4. Qualifying circumstances

Patients eligible to receive CPT 94005 services are those who require home ventilator management care plan oversight. This may include patients who are dependent on a ventilator for breathing assistance. The provider must review the patient’s status, laboratory values, and other studies to determine the need for revision of orders and the respiratory care plan. This service is performed in the patient’s home, domiciliary, or rest home (e.g., assisted living) without the patient present.

5. When to use CPT code 94005

CPT code 94005 should be used when a healthcare provider spends 30 minutes or more reviewing the patient’s status, laboratory values, and other studies, and revising orders and the respiratory care plan as necessary. This code should be reported separately from other assisted living services and should not be reported in conjunction with certain other codes (99374-99378, 99424, 99425, 99437, 99491).

6. Documentation requirements

To support a claim for CPT 94005, the healthcare provider must document the following information:

• Patient’s clinical status and need for home ventilator management care plan oversight
• Review of laboratory values and other studies
• Revision of orders and respiratory care plan, as appropriate
• Date and duration of the oversight and revision process (30 minutes or more)
• Signature of the healthcare provider performing the service

7. Billing guidelines

When billing for CPT 94005, ensure that the healthcare provider spends 30 minutes or more on the oversight and revision process. This code should be reported separately from other assisted living services and should not be reported with certain other codes (99374-99378, 99424, 99425, 99437, 99491). Review coding guidelines for reporting this service together with other supervision and care plan services.

8. Historical information

CPT 94005 was added to the Current Procedural Terminology system on January 1, 2007. There have been no updates to the code since its addition.

9. Examples

1. A healthcare provider spending 30 minutes reviewing a patient’s status, laboratory values, and other studies, and revising orders and the respiratory care plan for home ventilator management.
2. A provider overseeing and revising a patient’s home ventilator management care plan for 45 minutes based on assessment of clinical status and review of laboratory values.
3. A healthcare provider spending 30 minutes or more on the oversight and revision of a patient’s home ventilator management care plan in an assisted living facility.
4. A provider reviewing a patient’s status, laboratory values, and other studies, and revising orders and the respiratory care plan for home ventilator management for 30 minutes or more in a calendar month.
5. A healthcare provider spending 30 minutes or more on the oversight and revision of a patient’s home ventilator management care plan in the patient’s home.
6. A provider reviewing the patient’s clinical status, laboratory values, and results of other studies, and revising orders and the respiratory care plan for home ventilator management for 30 minutes or more in a calendar month.