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See a sample rate comparisonCPT 94013 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.
Lung Function Test, A Lung Function Test Evaluates Breathing Ability. Measures Include The Amount Of Air Entering Or Leaving The Body The Amount Of Oxygen Circulating To Organs And The Amount Of Air Left In The Lungs After Exhaling.
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Pulmonary Procedures |
| Common Place of Service | 11 - Office 50 - Federally Qualified Health Center 21 - Inpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | $16.70 national non-facility rate (2026) · View Medicare rates for 94013 |
| Medicaid Fee Schedule | $14.82 median of the 8 states in the free preview · View Medicaid rates for 94013 |
National average reimbursement for CPT 94013 by major payers:
$29.90
$31.72
$26.78
$45.81
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CPT 94013
5 of 25 sample ratesHigher to lower in this preview
Tamar Caceres
Pediatric Faculty Foundation In
$68.79Published rateMary Fahrmeier
$38.27Published rateRitu Talwar
Horizons Behavioral Health LLC
$33.06Published ratePaul Berkowitz
Presence Healthcare Services
$28.12Published rateErin Kelly
Town Center Orthopaedic Associates, P.C.
$15.76Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 94013 vs. Other Pulmonary Procedures Codes
The CPT 94013 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 94013 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 |
|---|---|---|
| 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 |
| 94011-CPT | Low | Spirometer Breath Test, This Test Involves Breathing Out Hard Into A Spirometer (Device For Measuring Airflow). The Spirometer Records The Amount And Rate Of Airflow. |
| 94012-CPT | Low | Breathing Test With Medication, Test To See How Well A Medication For Increasing Airflow To The Lungs (Bronchodilator) Works. The Person Breathes Into A Spirometer (Device For Measuring Airflow) Before Using The Medicine And Then Afterward. |
| 94013-CPT | Low | Lung Function Test, A Lung Function Test Evaluates Breathing Ability. Measures Include The Amount Of Air Entering Or Leaving The Body The Amount Of Oxygen Circulating To Organs And The Amount Of Air Left In The Lungs After Exhaling. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 94013. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 94013 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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