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See a sample rate comparisonCPT 94690 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.
Test For Oxygen Use, Lung Function Test That Measures The Amount Of Oxygen Absorbed Into The Blood. It Analyzes The Amount Of Oxygen In Exhaled Air To Learn How Much Oxygen The Body Is Using.
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Pulmonary Procedures |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | $52.44 national non-facility rate (2026) · View Medicare rates for 94690 |
| Medicaid Fee Schedule | $42.885 median of the 8 states in the free preview · View Medicaid rates for 94690 |
National average reimbursement for CPT 94690 by major payers:
$60.04
$68.39
$62.31
$80.90
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CPT 94690
5 of 25 sample ratesHigher to lower in this preview
David Hsu
Aurora Medical Group Inc
$170.16Published rateElton Smith
$91.87Published rateM Sheikh
Advocate Health And Hospitals Corporation
$82.50Published rateChristopher Johnson
Touchette Regional Hospital Inc
$48.34Published rateLaron Phillips
Brightside Medical
$4.30Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 94690 vs. Other Pulmonary Procedures Codes
The CPT 94690 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 94690 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 |
|---|---|---|
| 94680-CPT | Low | Test For Oxygen Use, Lung Function Test That Measures The Amount Of Oxygen Absorbed Into The Blood. It Analyzes The Amount Of Oxygen In Exhaled Air To Learn How Much Oxygen The Body Is Using. |
| 94681-CPT | Low | Test For Oxygen Use, Lung Function Test That Measures The Amount Of Oxygen Absorbed Into The Blood. It Analyzes The Amount Of Oxygen In Exhaled Air To Learn How Much Oxygen The Body Is Using. |
| 94690-CPT | Low | Test For Oxygen Use, Lung Function Test That Measures The Amount Of Oxygen Absorbed Into The Blood. It Analyzes The Amount Of Oxygen In Exhaled Air To Learn How Much Oxygen The Body Is Using. |
| 94726-CPT | Low | Whole-Body Air Volume Test, An Air Volume Test Measures Changes In The Amount Of Air Circulating In The Body While A Person Breathes. A Whole-Body Test Is Done In A Pressurized Room. The Test Is Called Plethysmography. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 94690. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 94690 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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