Pediatric Pulmonology, Allergy & CFTR Estimator
Pediatric pulmonology and cystic fibrosis practices face acute revenue threats from PFT unbundling audits (billing baseline 94010 with pre/post 94060), unbundled aerosol treatments, and stringent specialty pharmacy prior authorizations for targeted CFTR modulators (Trikafta, Kalydeco). Audit your pulmonary diagnostic panels, sweat testing, and biologic approvals with zero denial risk.
Pediatric Pulmonary Function & CFTR Therapy Estimator
Audit pediatric spirometry and plethysmography bundling, avoid fatal 94010 unbundling into 94060, ensure sweat chloride testing reimbursement, and secure prior authorizations for $300k+ annual CFTR modulator therapies.
Compliant Pediatric Pulmonary & CF Diagnostic Billing
PFT testing is appropriately bundled into CPT 94060. Sweat chloride and diagnostic allergen batteries satisfy medical necessity thresholds, and CFTR prior authorization dossier is 100% compliant.
| CPT Code | Description | Modifier | RVU | Est. Fee | Scrubber Rule Assessment |
|---|---|---|---|---|---|
| 94060 | Bronchodilator responsiveness evaluation (Spirometry pre- and post-bronchodilator) | None | 4.2 | $145.00 | CLEANEncompasses both baseline and post-bronchodilator testing; NCCI column 1 code. |
| 82435 | Chloride; other source (Pilocarpine iontophoresis quantitative sweat chloride) | None | 1.8 | $65.00 | CLEANGold-standard diagnostic test for Cystic Fibrosis. Must document quantitative collection (>= 60 mmol/L). |
| 94640 | Pressurized or nonpressurized inhalation treatment for acute airway obstruction | -59 / -XE | 1.2 | $45.00 | CLEANAdministered for bronchodilator challenge or acute wheezing management. |
| 95004 x20 | Percutaneous tests (scratch, puncture, prick) with allergenic extracts (20 antigens) | None | 4.0 | $170.00 | CLEANEnvironmental and food allergen diagnostic battery with positive/negative histamine controls. |
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Turn these Pediatric Pulmonology & Allergy RCM insights into recovered cash
Tired of PFT unbundling recoupments, sweat chloride diagnostic denials, or protracted prior authorization delays for high-cost CFTR therapies? Aethera's specialized pediatric pulmonary billing team secures maximum reimbursement. Let our senior AAPC-certified billing team audit 50 of your active claims or past denials — completely free, with guaranteed under-48-hour findings.
Test our scrub rules and appeal workflow on 50 real claims. Zero commitment, no credit card required.
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