When billing health plans for use of the NIOX family of products, physicians should consider using CPT code 95012 - Nitric oxide expired gas determination.
Physicians should only bill CPT code 95012 if they actually perform the NIOX test in their offices.
If the NIOX test is performed in a hospital or other free-standing facility, 95012 should not be used for physician interpretation and/or report on the test. Similarly, physicians should not bill an E&M visit only for test interpretation and/or report. If the NIOX test is performed as part of a significant, separately identifiable E&M office visit, providers should consider billing 95012 for the NIOX test and billing the most appropriate E&M visit type in conjunction with modifier -25 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service.
When performed in a hospital setting, CPT code 95012 is payable under the Outpatient Prospective Payment System (OPPS) (APC 367) with Status Code X – Ancillary Services (i.e., the procedure is payable under OPPS as a separate APC payment).