How much does Medicare pay for CPT 94016?

Medicare allowed an average of $24.25 per service and paid $18.60 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $61.77, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 94016?

Test to measure expiratory airflow and volume initiated by patient and evaluated by provider. It was billed 6,372 times to 5,404 Medicare beneficiaries by 81 providers in 2024.

Does 94016 pay differently in an office than a hospital?

Yes. The allowed amount averaged $24.14 in an office setting and $25.25 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 94016 most?

Pulmonary Disease, with 3,809 services from 41 clinicians. Next are Internal Medicine, Diagnostic Radiology, Physician Assistant.

CPT 94016

Test to measure expiratory airflow and volume initiated by patient and evaluated by provider

$24.25Medicare-allowed amount per service, averaged across 6,372 services

Providers submitted

$61.77

Asking price, not received

Medicare allowed

$24.25

The fee schedule figure

Medicare paid

$18.60

Balance is patient coinsurance

Providers submitted an average of $61.77 for this code and Medicare allowed $24.25 — 2.5× 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 $18.60 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $24.14
Hospital / facility: $25.25

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 5,783 services were billed in an office setting and 589 in a facility.

Services: 6,372
Beneficiaries: 5,404
Providers billing it: 81
Total allowed: $154,521

What Medicare pays for CPT 94016

Across 6,372 services billed by 81 providers to 5,404 beneficiaries, Medicare allowed an average of $24.25 per service. That is 1.2 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 94016

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pulmonary Disease	3,809	3,195	$24.36	41
Internal Medicine	1,314	1,107	$24.99	20
Diagnostic Radiology	309	305	$23.17	1
Physician Assistant	280	224	$22.86	2
Allergy/ Immunology	239	174	$23.50	3
Cardiology	128	128	$22.92	1
Family Practice	104	104	$23.65	5
Critical Care (Intensivists)	85	83	$23.64	3
Nurse Practitioner	69	55	$20.76	3
Pediatric Medicine	19	16	$25.78	1
General Practice	16	13	$23.67	1

94016 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
California	3,044	$24.73	$18.16	38
New York	739	$25.33	$17.23	6
Texas	570	$23.27	$17.44	4
Georgia	530	$22.74	$18.33	5
Florida	363	$24.10	$17.91	2
Arizona	319	$23.55	$17.60	4
Virginia	142	$23.63	$17.82	2
Iowa	112	$22.58	$17.88	1
Washington	110	$25.08	$15.49	2
New Jersey	104	$23.43	$18.69	2
Pennsylvania	53	$23.03	$17.69	2
Oklahoma	49	$22.40	$16.17	1
Indiana	37	$23.32	$17.29	1
North Carolina	35	$22.80	$18.69	1
Idaho	28	$22.77	$18.13	2
Wisconsin	25	$22.72	$18.73	1
Massachusetts	24	$25.39	$18.79	1
Connecticut	21	$24.53	$18.71	1
Utah	19	$21.92	$19.04	1
Illinois	14	$24.50	$17.43	1
Alabama	12	$21.32	$18.71	1
Missouri	11	$22.73	$18.79	1
Michigan	11	$23.93	$18.11	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
94003Follow-up inpatient or observation ventilation assistance and manageme$63.87

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.