CPT 94640 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Medicine Services and Procedures • Pulmonary Procedures |
| Common Place of Service | • 11 - Office • 20 - Urgent Care Facility |
| Common Modifiers | • None • 76 - Repeat procedure by same physician • 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 94640 |
National average reimbursement for CPT 94640 by major payers:
$16.36
$20.96
$17.87
$20.60
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 94640 | ||||||
United | 94640 | $35.41 | 1942461231 - ANUPAMA WADHWA | 756002868 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 94640 | $34.43 | 1760412621 - RHONDA LAMPEN | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | VA | Psychiatry Physician (2084P0800X) |
United | 94640 | $23.26 | 1336406628 - AKASH PATEL | 592766165 | FL | Cardiovascular Disease Physician (207RC0000X) |
United | 94640 | $23.62 | 1942330576 - NASIR SYED | 862358048 - (IL) INSIGHT CHICAGO INC | IL | Psychiatry Physician (2084P0800X) |
United | 94640 | $14.60 | 1043488661 - HUIJIAN WANG | 911896241 - (FL) COMPLETE CARDIOLOGY CARE, PA | FL | Cardiovascular Disease Physician (207RC0000X) |
United | 94640 | $11.93 | 1265883375 - JOCELYN LORENZO | 726000821 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 94640 | $48.59 | 1568752665 - ANDREW KNOX | 390817529 - ST VINCENT HOSPITAL-HOSPITAL SISTERS-THIRD ORDER OF ST FRANCIS | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 94640 | $35.25 | 1063471159 - MARK WAINWRIGHT | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | WA | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 94640 | $31.01 | 1477181071 - KEVIN VARGHESE | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | IL | Psychiatry Physician (2084P0800X) |
United | 94640 | $30.62 | 1508922964 - COLLEEN BUHRFIEND | 911780120 - (IL) RUSH UNIVERSITY MEDICAL CENTER | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 94640 | $16.03 | 1942525605 - IVAN BUITRAGO GUEVARA | 261869328 | FL | Cardiovascular Disease Physician (207RC0000X) |
United | 94640 | $116.69 | 1871912683 - LAUREN SCHUMACHER | 943281673 | IL | Psychiatry Physician (2084P0800X) |
United | 94640 | $30.62 | 1932130325 - ELIZABETH BERRY-KRAVIS | 911780160 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 94640 | $31.72 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 94640 | $35.25 | 1144203753 - HAIDAR KABBANI | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 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 |
|---|---|---|
| 94200-CPT | Low | Measurement Of Largest Amount Of Air Breathed In An Out Of Lungs Over One Minute |
| 94610-CPT | Low | Intrapulmonary Surfactant Administration By A Physician Or Other Qualified Health Care Professional Through Endotracheal Tube (Revised 01/01/13) |
| 94618-CPT | Low | Pulmonary Stress Testing (Eg, 6-Minute Walk Test), Including Measurement Of Heart Rate, Oximetry, And Oxygen Titration, When Performed |
| 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 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.
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