Reimbursement Information for Methacholine Challenge Testing

CODE OVERVIEW

J-7674 One unit for each milligram of Provocholine (methacholine chloride)
Each Provocholine vial contains 100mg of methacholine chloride
95070 One unit for administering the methacholine
94070 One unit which covers the multiple spirometric determinations included in the bronchospasm evaluation.

See the handout below for full descriptions and additional references.

Example
If you used a 100 mg vial of Provocholine for one patient, you would bill for 100 units under the J-code and should receive $52.80 (will be in effect January 1 through to March 31, 2018). Reimbursement for the CPT codes outlined above, vary based on region. To find out how much you should be reimbursed for each of the codes in your area visit CMS.gov (linked to CMS.gov) and use the Physician Fee Schedule Search.