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 94640 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.
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)
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Pulmonary Procedures |
| Common Place of Service | 11 - Office 20 - Urgent Care Facility |
| Common Modifiers | 76 - Repeat procedure by same physician 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | $8.68 national non-facility rate (2026) · View Medicare rates for 94640 |
| Medicaid Fee Schedule | $7.12 median of the 8 states in the free preview · View Medicaid rates for 94640 |
National average reimbursement for CPT 94640 by major payers:
$16.36
$20.96
$17.87
$20.98
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 94640.
CPT 94640
5 of 25 sample ratesHigher to lower in this preview
Lauren Schumacher
$116.69Published rateHaidar Kabbani
Pediatric Faculty Foundation In
$35.25Published rateElizabeth Berry-Kravis
$30.62Published ratePriti Singh
Associates In Pediatric Neurology Sc
$22.87Published rateHetain Patel
Mary Hitchcock Memorial Hospital
$8.93Published 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 94640 vs. Other Pulmonary Procedures Codes
The CPT 94640 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 94640 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 |
|---|---|---|
| 94610-CPT | Low | Intrapulmonary Surfactant Admi, Intrapulmonary Surfactant Administration By A Physician Or Other Qualified Health Care Professional Through Endotracheal Tube |
| 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) |
| 94642-CPT | Low | Pneumonia Inhalation Treatment, Inhalation Treatment For Pneumocystis Jiroveci. This Type Of Pneumonia Infects Immune-Compromised Individuals. |
| 94644-CPT | Low | Conti Nhalation Treatmn W/ Aerosol Medicat For Acute Airw, Continuous Inhalation Treatment With Aerosol Medication For Acute Airw |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 94640. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 94640 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 94640) and we'll show you how you compare in 15 minutes or less.
Frequently Asked Questions
CPT stands for Current Procedural Terminology. CPT codes are a set of medical codes used by physicians, allied health professionals, and hospitals to describe the services and procedures they perform. These codes are essential for accurate medical billing and reimbursement from insurance companies and are developed and maintained by the American Medical Association (AMA).
The cost of a medical procedure can vary significantly based on factors like your location, the specific healthcare provider, your insurance plan, and the complexity of the service. For an accurate estimate tailored to your specific situation, including CPT codes and your location, you can use a specialized fee schedule lookup tool like Payerprice. They offer a tool to search for specific procedure costs.
Healthcare costs vary widely due to a combination of factors, including the type of facility (e.g., hospital vs. outpatient clinic), geographic location, negotiated rates between providers and insurance companies, the provider's specific pricing structure, and the absence of a universal pricing standard. These variations can make it challenging to predict the exact cost of a service.
In healthcare, a fee schedule is a comprehensive list of fees used by health plans (like insurance companies) to determine the maximum amount they will pay for specific medical services, procedures, or supplies. These schedules are often structured around CPT codes and are crucial for calculating reimbursement rates for providers and determining patient out-of-pocket costs.
To find the fee schedule for a specific CPT code in your particular location, it's best to use a specialized fee schedule lookup tool. Payerprice offers a tool designed for this purpose, allowing users to search with specific CPT codes and locations to access relevant fee schedule data.