How much does Medicare pay for CPT 94200?

Medicare allowed an average of $14.70 per service and paid $11.39 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $53.23, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 94200?

Test to measure largest amount of air breathed in an out. It was billed 45,650 times to 38,192 Medicare beneficiaries by 366 providers in 2024.

Does 94200 pay differently in an office than a hospital?

Yes. The allowed amount averaged $15.52 in an office setting and $2.69 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 94200 most?

Pulmonary Disease, with 25,985 services from 178 clinicians. Next are Internal Medicine, Allergy/ Immunology, General Practice.

CPT 94200

Test to measure largest amount of air breathed in an out

$14.70Medicare-allowed amount per service, averaged across 45,650 services

Providers submitted

$53.23

Asking price, not received

Medicare allowed

$14.70

The fee schedule figure

Medicare paid

$11.39

Balance is patient coinsurance

Providers submitted an average of $53.23 for this code and Medicare allowed $14.70 — 3.6× 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 $11.39 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $15.52
Hospital / facility: $2.69

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 42,721 services were billed in an office setting and 2,929 in a facility.

Services: 45,650
Beneficiaries: 38,192
Providers billing it: 366
Total allowed: $671,055

What Medicare pays for CPT 94200

Across 45,650 services billed by 366 providers to 38,192 beneficiaries, Medicare allowed an average of $14.70 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 94200

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pulmonary Disease	25,985	22,925	$14.60	178
Internal Medicine	7,021	6,203	$15.46	64
Allergy/ Immunology	2,862	791	$15.08	12
General Practice	2,191	1,853	$16.15	5
Critical Care (Intensivists)	1,652	1,553	$12.80	16
Family Practice	1,147	806	$14.82	21
Nurse Practitioner	1,121	1,060	$12.95	32
Independent Diagnostic Testing Facility (IDTF)	1,008	953	$14.02	4
Cardiology	768	460	$13.61	7
Obstetrics & Gynecology	385	373	$15.67	1
Anesthesiology	339	291	$16.96	1
Pain Management	331	115	$11.92	1
Physician Assistant	235	226	$11.85	11
Undefined Physician type	202	197	$17.52	1
Emergency Medicine	147	147	$17.01	1

94200 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	17,256	$15.73	$10.91	79
New York	7,211	$17.80	$11.27	37
Florida	4,519	$14.08	$11.08	46
Alabama	3,805	$12.32	$11.18	23
Puerto Rico	1,722	$14.44	$11.00	15
New Jersey	1,720	$13.14	$9.24	21
Mississippi	1,551	$9.66	$8.55	18
Maryland	1,297	$15.08	$11.23	6
Missouri	1,051	$13.39	$11.47	10
Georgia	950	$12.13	$10.05	10
Texas	855	$13.46	$11.01	11
Arizona	789	$13.35	$10.63	28
North Carolina	695	$13.43	$11.48	8
Tennessee	395	$12.73	$11.33	6
Illinois	322	$8.93	$6.41	5
Massachusetts	319	$2.61	$2.09	2
Colorado	277	$12.71	$9.75	7
New Mexico	154	$13.07	$10.46	4
Indiana	142	$9.84	$8.50	3
Pennsylvania	127	$2.51	$1.98	5
District of Columbia	124	$17.31	$11.73	5
Connecticut	64	$12.10	$7.22	3
Wisconsin	59	$5.84	$4.75	3
South Carolina	47	$14.40	$11.72	1
Ohio	36	$13.65	$10.53	2
Oklahoma	34	$2.47	$1.26	2
Louisiana	33	$11.67	$10.39	2
Kentucky	29	$13.14	$11.74	1
Hawaii	27	$2.50	$2.02	1
Michigan	27	$13.66	$11.68	1
Arkansas	13	$2.18	$2.13	1

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.