Respiratory Question for the Week of April 7, 2025

Question:

What code do we report for venipuncture in 2025 and do you have any tips for billing?

Answer:

Report the Level I code 36415 to all payers including Medicare. Medicare will reimburse for the venipuncture procedure once per encounter. Be sure to differentiate between venipuncture, capillary collection, and draws from a line or access device. When collecting capillary specimens (36416), the related cost is considered by Medicare to be insignificant and should be bundled to the test procedure. For 2025, 36416 has again been assigned to status indicator “N,” meaning it is always packaged, and 36415 has been assigned to status indicator “Q4,” which means it will be conditionally packaged if billed on the same claim as a HCPCS code assigned a published status indicator “J1,” “J2,” “S,” “T,” “V,” “Q1,” “Q2,” or “Q3.” In other circumstances, payment will be made under the Clinical Laboratory Fee Schedule (CLFS). Blood specimen collection performed during an IV start is not separately billable.

This question was answered in our Coding Essentials for RT/Pulmonary Function. For more hot topics relating to respiratory services, please visit our store or call us at 1.800.252.1578, ext. 2.