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See a sample rate comparisonCPT 94200 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 22 - On Campus Outpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | $16.37 national non-facility rate (2026) · View Medicare rates for 94200 |
| Medicaid Fee Schedule | $13.22 median of the 8 states in the free preview · View Medicaid rates for 94200 |
National average reimbursement for CPT 94200 by major payers:
$21.74
$29.08
$25.68
$29.97
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CPT 94200
5 of 25 sample ratesHigher to lower in this preview
Joshua Straus
Northshore University Healthsystem Faculty Practice Associates
$49.93Published rateDavid Hanrahan
Loyola University Medical Center
$33.84Published ratePeter Heydemann
Veterans Assistance Commission C
$29.79Published rateTrilok Shah
Ascension Medical Group-Fox Valley Wisconsin Inc
$15.81Published rateMelissa Wagner-Schuman
The Board Of Trustees Of The University Of Illinois
$6.15Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 94200 vs. Other Pulmonary Procedures Codes
The CPT 94200 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 94200 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 |
|---|---|---|
| 94150-CPT | Low | Test Amount Of Air Exhaled, Test To Measure Maximum Amount Of Air That Can Be Breathed Out. |
| 94200-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. |
| 94375-CPT | Low | Test Change In Lung Volume, Measurement Of The Changes In Lung Volume Over Time As During A Series Of Tests. The Curve Described By The Values Can Help To Locate The Exact Place Where Airflow Is Restricted. |
| 94640-CPT | Low | Pressurized Or Nonpressurized Inhalation Treatmentfor Acute Airway Obstruction For Therapeutic Purposes And/Or For Diagnostic Purposes (Such As Sputum Induction With An Aerosol Generator Nebulizer Metered Dose Inhaler Or Intermittent Positive Pressure Breathing (Ippb) Device) (Desc Revised 01/01/2016) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 94200. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 94200 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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