How much does Medicare pay for CPT 94626?

Medicare allowed an average of $90.73 per service and paid $71.90 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $194.17, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 94626?

Professional services for outpatient pulmonary rehabilitation with continuous monitoring of blood oxygen, per session. It was billed 47,706 times to 2,559 Medicare beneficiaries by 35 providers in 2024.

Does 94626 pay differently in an office than a hospital?

Yes. The allowed amount averaged $91.03 in an office setting and $25.87 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 94626 most?

Emergency Medicine, with 33,764 services from 2 clinicians. Next are Pulmonary Disease, Internal Medicine, Cardiology.

CPT 94626

Professional services for outpatient pulmonary rehabilitation with continuous monitoring of blood oxygen, per session

$90.73Medicare-allowed amount per service, averaged across 47,706 services

Providers submitted

$194.17

Asking price, not received

Medicare allowed

$90.73

The fee schedule figure

Medicare paid

$71.90

Balance is patient coinsurance

Providers submitted an average of $194.17 for this code and Medicare allowed $90.73 — 2.1× 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 $71.90 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $91.03
Hospital / facility: $25.87

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. 47,484 services were billed in an office setting and 222 in a facility.

Services: 47,706
Beneficiaries: 2,559
Providers billing it: 35
Total allowed: $4,328,365

What Medicare pays for CPT 94626

Across 47,706 services billed by 35 providers to 2,559 beneficiaries, Medicare allowed an average of $90.73 per service. That is 18.6 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 94626

Specialty	Services	Beneficiaries	Avg allowed	Providers
Emergency Medicine	33,764	1,292	$92.03	2
Pulmonary Disease	7,633	905	$84.52	26
Internal Medicine	2,436	136	$94.58	2
Cardiology	2,036	122	$98.25	1
Geriatric Medicine	1,265	40	$78.53	1
Neurology	432	35	$82.01	1
Sleep Medicine	119	14	$73.35	1
Critical Care (Intensivists)	21	15	$93.79	1

94626 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	18,819	$91.99	$62.46	1
Texas	15,288	$91.74	$62.35	2
New York	6,511	$95.30	$62.03	15
California	1,897	$94.68	$62.12	2
Ohio	1,321	$77.53	$62.54	1
Nevada	1,265	$78.53	$62.11	1
Florida	704	$75.80	$61.52	1
Maryland	624	$79.85	$61.01	5
Washington	432	$82.01	$62.10	1
New Hampshire	302	$80.57	$62.33	1
Michigan	202	$75.44	$61.06	1
Pennsylvania	138	$25.87	$19.27	2
Indiana	119	$73.35	$60.22	1
Massachusetts	84	$25.86	$21.09	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
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.