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See a sample rate comparisonCPT 94004 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Ventilation Assist And Managem, Ventilation Assist And Management Initiation Of Pressure Or Volume Preset Ventilators For Assisted Or Controlled Breathing Nursing Facility Per Day
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Pulmonary Procedures |
| Common Place of Service | 99 - Other POS |
| Common Modifiers | 59 - Distinct Procedural Service 95 - Telemedicine - audio and video |
| Complexity Level | Low |
| Medicare Fee Schedule | $43.76 national non-facility rate (2026) · View Medicare rates for 94004 |
| Medicaid Fee Schedule | $37.18 median of the 8 states in the free preview · View Medicaid rates for 94004 |
National average reimbursement for CPT 94004 by major payers:
$65.24
$62.43
$59.14
$85.26
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CPT 94004
5 of 25 sample ratesHigher to lower in this preview
Lauren Schumacher
$274.54Published rateMatthew Niedzwiecki
$98.13Published rateJennifer Sprague
Advocate Health And Hospitals Corporation
$88.62Published rateNancy Schell
Patient First Inc
$74.19Published rateCollin Messerly
Town Center Orthopaedic Associates, P.C.
$45.17Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 94004 vs. Other Pulmonary Procedures Codes
The CPT 94004 code is part of the Medicine Services and Procedures services used for Pulmonary Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 94004 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 94002-CPT | Low | Ventilation Assist And Managem, Ventilation Assist And Management Initiation Of Pressure Or Volume Preset Ventilators For Assisted Or Controlled Breathing Hospital Inpatientobservation Initial Day |
| 94003-CPT | Low | Ventilation Assist And Managem, Ventilation Assist And Management Initiation Of Pressure Or Volume Preset Ventilators For Assisted Or Controlled Breathing Hospital Inpatientobservation Each Subsequent Day |
| 94004-CPT | Low | Ventilation Assist And Managem, Ventilation Assist And Management Initiation Of Pressure Or Volume Preset Ventilators For Assisted Or Controlled Breathing Nursing Facility Per Day |
| 94010-CPT | Low | Spirometry Including Graphic, Spirometry Including Graphic Record Total And Timed Vital Capacity Expiratory Flow Rate Measurement(S) With Or Without Maximal Voluntary Ventilation |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 94004. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 94004 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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