How much does Medicare pay for CPT 94618?

Medicare allowed an average of $28.91 per service and paid $22.11 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $115.23, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 94618?

Test for exercise-induced lung stress. It was billed 224,424 times to 198,823 Medicare beneficiaries by 4,055 providers in 2024.

Does 94618 pay differently in an office than a hospital?

Yes. The allowed amount averaged $31.79 in an office setting and $21.39 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 94618 most?

Pulmonary Disease, with 157,887 services from 2,778 clinicians. Next are Critical Care (Intensivists), Internal Medicine, Nurse Practitioner.

CPT 94618

Test for exercise-induced lung stress

$28.91Medicare-allowed amount per service, averaged across 224,424 services

Providers submitted

$115.23

Asking price, not received

Medicare allowed

$28.91

The fee schedule figure

Medicare paid

$22.11

Balance is patient coinsurance

Providers submitted an average of $115.23 for this code and Medicare allowed $28.91 — 4.0× 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 $22.11 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $31.79
Hospital / facility: $21.39

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. 162,322 services were billed in an office setting and 62,102 in a facility.

Services: 224,424
Beneficiaries: 198,823
Providers billing it: 4,055
Total allowed: $6,488,098

What Medicare pays for CPT 94618

Across 224,424 services billed by 4,055 providers to 198,823 beneficiaries, Medicare allowed an average of $28.91 per service. 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 94618

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pulmonary Disease	157,887	142,056	$28.98	2,778
Critical Care (Intensivists)	19,344	17,370	$28.73	338
Internal Medicine	19,291	15,907	$29.91	340
Nurse Practitioner	11,419	10,302	$26.07	328
Cardiology	2,876	2,314	$26.47	60
Physician Assistant	2,380	2,236	$26.61	78
Physical Medicine and Rehabilitation	2,264	927	$29.59	2
Independent Diagnostic Testing Facility (IDTF)	1,922	1,478	$32.63	8
Sleep Medicine	1,164	1,073	$28.09	21
General Practice	947	792	$34.71	6
Emergency Medicine	880	704	$34.73	12
Advanced Heart Failure and Transplant Cardiology	799	692	$28.54	27
Family Practice	697	627	$33.73	13
Hospitalist	667	642	$29.44	13
Allergy/ Immunology	506	493	$20.19	6

94618 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
Texas	24,081	$28.77	$22.67	335
Florida	23,097	$30.99	$23.81	331
California	19,634	$32.18	$22.82	295
Illinois	12,231	$27.61	$20.77	176
Pennsylvania	12,167	$26.50	$20.20	240
New York	10,672	$34.39	$23.69	211
North Carolina	10,071	$27.13	$21.52	143
Georgia	8,936	$31.42	$24.26	218
Ohio	8,205	$23.88	$18.54	163
Virginia	7,201	$27.91	$21.03	129
New Jersey	6,884	$33.95	$23.94	125
Missouri	6,608	$26.01	$20.25	95
Michigan	5,579	$26.55	$19.84	134
South Carolina	5,308	$27.94	$22.30	103
Arizona	5,241	$30.49	$23.33	87
Maryland	4,832	$31.76	$23.61	77
Minnesota	4,476	$26.49	$20.00	60
Indiana	4,202	$26.49	$21.33	91
Washington	3,561	$30.41	$21.87	65
Alabama	3,547	$28.27	$23.74	84
Connecticut	3,097	$30.32	$21.78	80
Tennessee	3,022	$26.40	$21.50	73
Wisconsin	2,955	$24.73	$19.35	58
Nevada	2,942	$30.82	$24.29	37
Massachusetts	2,891	$25.81	$18.69	78
Colorado	2,623	$31.50	$23.82	43
Arkansas	2,215	$25.23	$20.70	40
Kentucky	2,154	$26.72	$21.43	66
Louisiana	1,934	$22.77	$17.76	39
Mississippi	1,763	$27.05	$23.06	19
Nebraska	1,404	$25.91	$20.59	38
New Mexico	1,281	$28.18	$21.89	25
Kansas	1,034	$22.95	$18.36	32
West Virginia	805	$22.10	$16.47	28
Oregon	801	$27.73	$20.85	28
Delaware	799	$26.24	$19.56	18
Vermont	689	$20.68	$15.97	20
Iowa	614	$25.34	$20.13	22
Maine	590	$29.31	$21.16	18
Oklahoma	577	$25.18	$20.35	19
South Dakota	532	$20.64	$15.59	12
District of Columbia	476	$32.69	$22.80	13
Utah	460	$27.07	$21.80	16
Rhode Island	452	$29.87	$21.97	15
New Hampshire	438	$23.69	$18.06	17
North Dakota	426	$22.51	$17.41	12
Idaho	271	$23.08	$18.13	10
Alaska	207	$32.17	$18.08	5
Guam	161	$25.31	$18.60	3
Puerto Rico	117	$33.00	$25.76	4
Montana	97	$33.49	$25.47	3
Hawaii	36	$20.14	$16.93	1
Wyoming	28	$28.18	$22.63	1

Related codes

94640Inhalation treatment for airway obstruction or sputum production$7.68
94664Evaluation of use of breathing device$17.91
94626Professional services for outpatient pulmonary rehabilitation$90.73
94625Professional services for outpatient pulmonary rehabilitation$76.69
94660Therapy procedure$63.51
94621Test for exercise-induced heart and lung stress$106.22
94690Test to measure exhaled air for evaluation of lung function at rest$44.15
94617Test for exercise-induced spasm of lung airways$73.45
94644Inhalation treatment for acute airway obstruction$62.88
94619Exercise test for spasm of lung airways$50.44
94681Test to measure exhaled air and carbon dioxide for evaluation of lung$23.41
94667Initial therapy service to facilitate lung function$26.89

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.