Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 94625 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.
Physician Or Other Qualified H, Physician Or Other Qualified Health Care Professional Services For Outpatient Pulmonary Rehabilitation Without Continuous Oximetry Monitoring (Per Session)
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Pulmonary Procedures |
| Common Place of Service | 11 - Office |
| Common Modifiers | PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments KX - Requirements specified in the medical policy have been met |
| Complexity Level | Low |
| Medicare Fee Schedule | $87.18 national non-facility rate (2026) · View Medicare rates for 94625 |
| Medicaid Fee Schedule | $68.57 median of the 8 states in the free preview · View Medicaid rates for 94625 |
National average reimbursement for CPT 94625 by major payers:
$74.21
$86.80
$76.05
$116.86
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 94625.
CPT 94625
5 of 25 sample ratesHigher to lower in this preview
Rhonda Lampen
Multicare Health System
$181.33Published rateLubov Romantseva
Pediatric Faculty Foundation In
$143.00Published rateLubov Romantseva
Rush University Medical Center
$116.95Published rateAsifa Choudhry
Carle West Physician Group Inc
$95.12Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$8.34Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 94625 vs. Other Pulmonary Procedures Codes
The CPT 94625 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 94625 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. |
| 94625-CPT | Low | Physician Or Other Qualified H, Physician Or Other Qualified Health Care Professional Services For Outpatient Pulmonary Rehabilitation Without Continuous Oximetry Monitoring (Per Session) |
| 94626-CPT | Low | Physician Or Other Qualified H, Physician Or Other Qualified Health Care Professional Services For Outpatient Pulmonary Rehabilitation With Continuous Oximetry Monitoring (Per Session) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 94625. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 94625 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 94625) and we'll show you how you compare in 15 minutes or less.