How much does Medicare pay for CPT 94664?

Medicare allowed an average of $17.91 per service and paid $13.72 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $45.61, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 94664?

Evaluation of use of breathing device. It was billed 87,680 times to 65,267 Medicare beneficiaries by 1,275 providers in 2024.

Does 94664 pay differently in an office than a hospital?

Yes. The allowed amount averaged $17.91 in an office setting and $20.38 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 94664 most?

Pulmonary Disease, with 53,540 services from 648 clinicians. Next are Internal Medicine, Allergy/ Immunology, Nurse Practitioner.

CPT 94664

Evaluation of use of breathing device

$17.91Medicare-allowed amount per service, averaged across 87,680 services

Providers submitted

$45.61

Asking price, not received

Medicare allowed

$17.91

The fee schedule figure

Medicare paid

$13.72

Balance is patient coinsurance

Providers submitted an average of $45.61 for this code and Medicare allowed $17.91 — 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 $13.72 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $17.91
Hospital / facility: $20.38

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 87,648 services were billed in an office setting and 32 in a facility.

Services: 87,680
Beneficiaries: 65,267
Providers billing it: 1,275
Total allowed: $1,570,349

What Medicare pays for CPT 94664

Across 87,680 services billed by 1,275 providers to 65,267 beneficiaries, Medicare allowed an average of $17.91 per service. That is 1.3 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 94664

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pulmonary Disease	53,540	39,613	$18.11	648
Internal Medicine	11,197	8,393	$18.44	162
Allergy/ Immunology	5,966	4,348	$18.18	134
Nurse Practitioner	5,838	4,767	$14.88	123
Critical Care (Intensivists)	4,615	3,527	$17.94	78
Family Practice	2,315	1,641	$17.40	63
Physician Assistant	1,367	1,097	$15.99	26
General Practice	855	120	$20.60	2
Cardiology	796	776	$20.01	6
Emergency Medicine	432	324	$17.21	11
Sleep Medicine	262	229	$18.16	6
Pediatric Medicine	139	110	$16.53	4
Hospitalist	118	111	$17.10	4
Physical Medicine and Rehabilitation	84	73	$18.10	1
Anesthesiology	50	45	$20.65	1

94664 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	13,699	$19.98	$13.25	140
Florida	11,495	$17.63	$13.45	144
New York	9,201	$21.07	$13.47	108
Texas	8,155	$16.81	$13.43	101
Alabama	3,411	$14.58	$13.05	37
Illinois	3,165	$17.25	$13.16	35
New Jersey	2,954	$19.93	$13.64	50
Mississippi	2,707	$14.45	$13.49	13
Maryland	2,659	$18.39	$13.24	37
Arizona	2,511	$17.16	$13.57	35
Pennsylvania	2,384	$18.33	$13.49	39
Nevada	2,287	$17.29	$13.41	12
North Carolina	2,122	$15.75	$13.31	49
Virginia	1,901	$18.02	$12.89	37
Georgia	1,851	$16.02	$13.48	44
Ohio	1,816	$16.50	$13.57	29
Delaware	1,680	$17.55	$13.02	5
Connecticut	1,400	$19.13	$13.32	31
Michigan	1,376	$16.97	$13.08	40
Kentucky	1,196	$15.50	$13.59	36
Tennessee	1,151	$15.22	$13.63	30
Oklahoma	1,104	$19.26	$13.76	7
Indiana	986	$15.61	$12.80	32
South Carolina	972	$15.68	$13.36	36
Louisiana	932	$14.91	$13.06	15
Colorado	593	$18.15	$12.71	16
Missouri	550	$15.61	$13.49	12
Arkansas	537	$14.79	$13.67	6
Massachusetts	478	$19.84	$13.49	15
Kansas	327	$15.44	$12.53	8
Oregon	323	$17.42	$13.51	10
Puerto Rico	311	$16.59	$13.52	7
Minnesota	193	$17.35	$13.45	10
Nebraska	172	$15.07	$13.25	8
Washington	163	$17.89	$12.42	8
Rhode Island	161	$17.70	$12.77	3
Iowa	144	$15.22	$12.62	8
Utah	132	$15.20	$12.06	4
New Hampshire	99	$18.85	$13.20	1
Wisconsin	86	$16.54	$13.01	3
District of Columbia	73	$21.06	$13.69	3
West Virginia	57	$14.41	$13.00	3
Alaska	53	$18.83	$14.09	2
South Dakota	37	$15.60	$12.72	2
U.S. Virgin Islands	28	$17.00	$13.99	1
Montana	25	$18.32	$13.52	2
New Mexico	23	$15.54	$12.50	1

Related codes

94618Test for exercise-induced lung stress$28.91
94640Inhalation treatment for airway obstruction or sputum production$7.68
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.