How much does Medicare pay for CPT 94003?

Medicare allowed an average of $63.87 per service and paid $50.69 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $189.77, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 94003?

Follow-up inpatient or observation ventilation assistance and management. It was billed 11,035 times to 1,382 Medicare beneficiaries by 55 providers in 2024.

Does 94003 pay differently in an office than a hospital?

Yes. The allowed amount averaged $60.63 in an office setting and $63.88 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 94003 most?

Pulmonary Disease, with 8,901 services from 39 clinicians. Next are Internal Medicine, Critical Care (Intensivists), Nurse Practitioner.

CPT 94003

Follow-up inpatient or observation ventilation assistance and management

$63.87Medicare-allowed amount per service, averaged across 11,035 services

Providers submitted

$189.77

Asking price, not received

Medicare allowed

$63.87

The fee schedule figure

Medicare paid

$50.69

Balance is patient coinsurance

Providers submitted an average of $189.77 for this code and Medicare allowed $63.87 — 3.0× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $50.69 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $60.63
Hospital / facility: $63.88

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 51 services were billed in an office setting and 10,984 in a facility.

Services: 11,035
Beneficiaries: 1,382
Providers billing it: 55
Total allowed: $704,805

What Medicare pays for CPT 94003

Across 11,035 services billed by 55 providers to 1,382 beneficiaries, Medicare allowed an average of $63.87 per service. That is 8.0 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 94003

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pulmonary Disease	8,901	1,017	$64.20	39
Internal Medicine	1,422	196	$64.88	7
Critical Care (Intensivists)	292	58	$62.24	3
Nurse Practitioner	234	30	$51.38	2
Physician Assistant	98	23	$56.04	1
General Surgery	60	30	$61.12	2
Cardiac Surgery	28	28	$60.57	1

94003 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Illinois	3,950	$65.13	$49.11	18
Pennsylvania	2,241	$62.42	$49.42	5
Michigan	1,366	$64.60	$49.45	3
New Jersey	805	$67.35	$49.28	3
Massachusetts	530	$65.39	$49.46	5
Tennessee	445	$59.02	$49.47	2
South Carolina	312	$60.42	$49.34	4
Florida	299	$64.02	$49.09	4
New York	268	$70.43	$48.86	1
Minnesota	222	$51.03	$41.87	1
North Carolina	155	$60.22	$48.84	2
Kentucky	153	$60.43	$49.47	2
Georgia	91	$60.34	$49.54	1
Ohio	90	$60.69	$47.61	1
Texas	60	$61.12	$49.49	2
Alabama	48	$59.30	$47.58	1

Related codes

94010Test to measure expiratory airflow and volume$21.18
94060Test to measure expiratory airflow and volume changes before and after$27.89
94004Nursing facility ventilation assistance and management$47.32
94070Test to measure lung airway sensitivity$56.92
94016Test to measure expiratory airflow and volume initiated by patient and$24.25

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.