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See a sample rate comparisonCPT 94642 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.
Pneumonia Inhalation Treatment, Inhalation Treatment For Pneumocystis Jiroveci. This Type Of Pneumonia Infects Immune-Compromised Individuals.
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Pulmonary Procedures |
| Common Place of Service | 11 - Office 20 - Urgent Care Facility |
| Common Modifiers | 59 - Distinct Procedural Service U6 |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 94642 |
| Medicaid Fee Schedule | $34.505 median of the 8 states in the free preview · View Medicaid rates for 94642 |
National average reimbursement for CPT 94642 by major payers:
$71.42
$50.32
$49.54
$63.49
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CPT 94642
5 of 25 sample ratesHigher to lower in this preview
Sonam Verma
$167.30Published rateDavid Banayan
Loyola University Medical Center
$61.66Published rateJacqueline Pardo
University Of Chicago
$57.00Published rateBarry Rabin
Edward Health Ventures
$48.68Published rateKapil Aedma
Swope Health Services
$15.42Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 94642 vs. Other Pulmonary Procedures Codes
The CPT 94642 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 94642 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 94642. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 94642 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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