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See a sample rate comparisonCPT 94626 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 With Continuous Oximetry Monitoring (Per Session)
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Pulmonary Procedures |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | 95 - Telemedicine - audio and video KX - Requirements specified in the medical policy have been met |
| Complexity Level | Low |
| Medicare Fee Schedule | $109.22 national non-facility rate (2026) · View Medicare rates for 94626 |
| Medicaid Fee Schedule | $80.325 median of the 8 states in the free preview · View Medicaid rates for 94626 |
National average reimbursement for CPT 94626 by major payers:
$86.46
$98.84
$91.36
$59.05
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CPT 94626
5 of 25 sample ratesHigher to lower in this preview
Srishti Nangia
$233.58Published rateElton Smith
$151.02Published rateRhonda Lampen
Loyola University Medical Center
$145.58Published rateKathryn Abell
Northwestern Memorial Healthcare
$115.68Published rateLaron Phillips
Brightside Medical
$31.75Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 94626 vs. Other Pulmonary Procedures Codes
The CPT 94626 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 94626 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 |
|---|---|---|
| 94015-CPT | Low | 30-Day Breathing Test, A 30-Day Breathing Test To Assess Lung Function For A Condition Such As Asthma. Once Each Day A Person Breathes Into A Spirometer (Device For Measuring Airflow) To Record The Amount And Rate Of Air Intake And Outflow. |
| 94150-CPT | Low | Test Amount Of Air Exhaled, Test To Measure Maximum Amount Of Air That Can Be Breathed Out. |
| 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 94626. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 94626 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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