How much does Medicare pay for CPT 94681?

Medicare allowed an average of $23.41 per service and paid $18.03 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $123.63, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 94681?

Test to measure exhaled air and carbon dioxide for evaluation of lung function. It was billed 2,552 times to 2,460 Medicare beneficiaries by 33 providers in 2024.

Does 94681 pay differently in an office than a hospital?

Yes. The allowed amount averaged $49.83 in an office setting and $9.28 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 94681 most?

Cardiology, with 1,664 services from 16 clinicians. Next are Pulmonary Disease, Neurology, Internal Medicine.

CPT 94681

Test to measure exhaled air and carbon dioxide for evaluation of lung function

$23.41Medicare-allowed amount per service, averaged across 2,552 services

Providers submitted

$123.63

Asking price, not received

Medicare allowed

$23.41

The fee schedule figure

Medicare paid

$18.03

Balance is patient coinsurance

Providers submitted an average of $123.63 for this code and Medicare allowed $23.41 — 5.3× 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 $18.03 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $49.83
Hospital / facility: $9.28

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. 889 services were billed in an office setting and 1,663 in a facility.

Services: 2,552
Beneficiaries: 2,460
Providers billing it: 33
Total allowed: $59,742

What Medicare pays for CPT 94681

Across 2,552 services billed by 33 providers to 2,460 beneficiaries, Medicare allowed an average of $23.41 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 94681

Specialty	Services	Beneficiaries	Avg allowed	Providers
Cardiology	1,664	1,650	$10.81	16
Pulmonary Disease	626	580	$49.79	8
Neurology	87	66	$56.65	3
Internal Medicine	60	54	$48.67	2
Advanced Heart Failure and Transplant Cardiology	60	59	$8.89	2
Nurse Practitioner	40	39	$38.43	1
Critical Care (Intensivists)	15	12	$44.01	1

94681 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
Minnesota	1,318	$10.37	$7.34	12
California	397	$54.07	$36.83	4
Arizona	273	$12.82	$9.81	3
Florida	241	$40.22	$33.37	4
New York	157	$35.51	$23.71	5
Wisconsin	62	$22.90	$17.21	2
Pennsylvania	57	$43.46	$35.20	2
Mississippi	47	$40.94	$36.11	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
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
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.