READY TO COME SEE US?

Here's what to expect during your first visit, including Patient Forms

and Insurance Information

SCHEDULE YOUR APPOINTMENT BELOW

WHAT TO BRING

- Your completed Patient Formsmedical insurance card and photo ID.

If you were asked to complete the Pulmonary Function Test or Sleep History Questionnaire,        please bring those as well. 

If you are unable to download or complete the forms, please arrive at our office 30 minutes prior to your appointment.

(click to download)

PATIENT
FORMS

INSURANCE

We accept most health insurance plans, however, it is your responsibility to contact your insurance carrier to verify coverage and benefits. Patients may be held financially responsible for payment of services should the insurance company deny responsibility.

*We are now accepting Kaiser Permanente plans

 

Please bring your insurance card with you each time you visit Covenant Pulmonary Critical Care. In the event of changes in your insurance coverage please notify the front desk so we can accurately maintain your medical records.

SELF PAY RATES

PLEASE NOTE: If a patient has active insurance coverage at the time of service, you are not considered self-pay. By law, we are required to bill your insurance.

PHYSICIAN VISITS

SERVICE

BILLING (CPT) CODE

SELF-PAY RATE

Office Visit - New Patient

Office Visit - Established Patient

99203-99204

99213-99214

$280.00

$102.00

** Complex visits may be billed at a higher level of service and cost

PROCEDURES & TESTS

SERVICE

BILLING (CPT) CODE

SELF-PAY RATE

Breathing Capacity Test (Basic Spirometry)

Overnight Oximetry

94010

94762

$130.00

$102.00

94618

$83.00

PULMONARY FUNCTION TEST (PFT)

SERVICE

BILLING (CPT) CODE

SELF-PAY RATE

Evaluation of Bronchospasm

94060

Breathing Capacity Test

94010

$180.00

$85.64

Full PFT including Lung Volume

94060, 94726, 94729

$255.00

(Pre-, Post-, Spirometry)

w/Plethysmogrophy, DLCO

** A PFT consists of either (but never both) CPT 94060 or 94010 and one or more of the other CPT codes.
The total cost can range from $130-$330

PHYSICIAN VISITS

SERVICE

BILLING (CPT) CODE

SELF-PAY RATE

Home Sleep Study

95806

$212.50

Pulmonary Stress Test (6MWT)