How much does Medicare pay for CPT 94621?

Medicare allowed an average of $106.22 per service and paid $81.38 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $358.02, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 94621?

Test for exercise-induced heart and lung stress. It was billed 12,674 times to 12,136 Medicare beneficiaries by 352 providers in 2024.

Does 94621 pay differently in an office than a hospital?

Yes. The allowed amount averaged $134.95 in an office setting and $66.81 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 94621 most?

Pulmonary Disease, with 4,529 services from 124 clinicians. Next are Cardiology, Internal Medicine, Advanced Heart Failure and Transplant Cardiology.

CPT 94621

Test for exercise-induced heart and lung stress

$106.22Medicare-allowed amount per service, averaged across 12,674 services

Providers submitted

$358.02

Asking price, not received

Medicare allowed

$106.22

The fee schedule figure

Medicare paid

$81.38

Balance is patient coinsurance

Providers submitted an average of $358.02 for this code and Medicare allowed $106.22 — 3.4× 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 $81.38 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $134.95
Hospital / facility: $66.81

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. 7,330 services were billed in an office setting and 5,344 in a facility.

Services: 12,674
Beneficiaries: 12,136
Providers billing it: 352
Total allowed: $1,346,232

What Medicare pays for CPT 94621

Across 12,674 services billed by 352 providers to 12,136 beneficiaries, Medicare allowed an average of $106.22 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 94621

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pulmonary Disease	4,529	4,386	$103.65	124
Cardiology	4,209	4,064	$101.33	108
Internal Medicine	1,462	1,333	$141.03	30
Advanced Heart Failure and Transplant Cardiology	1,175	1,159	$74.81	49
Nurse Practitioner	448	365	$88.82	8
Critical Care (Intensivists)	329	319	$127.75	15
Clinical Cardiac Electrophysiology	198	191	$163.93	3
Family Practice	160	156	$144.53	6
Orthopedic Surgery	46	45	$141.19	2
Diagnostic Radiology	30	30	$145.26	1
Interventional Cardiology	28	28	$137.08	2
Allergy/ Immunology	25	25	$64.79	1
Physical Medicine and Rehabilitation	13	13	$72.83	1
Sleep Medicine	11	11	$72.38	1
Adult Congenital Heart Disease	11	11	$65.59	1

94621 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	2,000	$105.35	$83.02	29
New York	1,628	$127.95	$85.83	40
California	1,338	$115.26	$82.05	32
Florida	1,259	$132.72	$104.29	32
Massachusetts	1,044	$80.20	$56.63	24
Georgia	501	$127.88	$107.00	7
New Jersey	448	$142.66	$99.79	12
Arizona	360	$96.49	$74.92	10
Illinois	324	$81.79	$59.81	12
Ohio	320	$64.20	$48.66	15
North Carolina	259	$83.14	$65.17	12
Tennessee	257	$121.99	$101.90	7
Arkansas	237	$125.18	$110.88	5
Pennsylvania	225	$65.02	$48.73	12
Connecticut	225	$98.38	$69.49	8
Alabama	224	$115.22	$96.39	7
Virginia	191	$72.22	$54.18	8
Maryland	172	$152.98	$105.55	5
Kentucky	155	$81.68	$65.52	4
Indiana	142	$62.86	$48.32	5
Louisiana	134	$63.65	$49.55	6
Michigan	126	$66.13	$50.34	7
Wisconsin	118	$61.04	$49.46	7
North Dakota	91	$63.66	$50.10	2
Oklahoma	90	$70.40	$55.91	4
Minnesota	79	$96.24	$76.89	2
Nebraska	69	$133.93	$98.70	2
Idaho	68	$61.81	$50.09	3
Missouri	64	$63.58	$49.12	4
Kansas	64	$64.23	$51.83	5
Colorado	60	$66.04	$48.38	4
Delaware	59	$64.79	$50.26	1
Washington	50	$68.46	$50.59	3
South Carolina	45	$100.56	$79.87	2
Oregon	42	$67.83	$48.39	2
Alaska	42	$183.08	$117.78	2
New Hampshire	34	$120.35	$91.45	2
District of Columbia	29	$110.47	$102.68	2
Rhode Island	26	$66.50	$51.87	1
Hawaii	20	$63.64	$52.37	1
Montana	17	$66.63	$51.73	1
Vermont	13	$63.72	$44.08	1
Maine	13	$67.53	$47.74	1
Iowa	12	$62.28	$51.86	1

Related codes

94618Test for exercise-induced lung stress$28.91
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
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.