How much does Medicare pay for CPT 94690?

Medicare allowed an average of $44.15 per service and paid $33.16 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $135.61, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 94690?

Test to measure exhaled air for evaluation of lung function at rest. It was billed 6,937 times to 5,388 Medicare beneficiaries by 130 providers in 2024.

Does 94690 pay differently in an office than a hospital?

Yes. The allowed amount averaged $47.15 in an office setting and $3.55 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 94690 most?

Internal Medicine, with 2,257 services from 39 clinicians. Next are Pulmonary Disease, Nurse Practitioner, Cardiology.

CPT 94690

Test to measure exhaled air for evaluation of lung function at rest

$44.15Medicare-allowed amount per service, averaged across 6,937 services

Providers submitted

$135.61

Asking price, not received

Medicare allowed

$44.15

The fee schedule figure

Medicare paid

$33.16

Balance is patient coinsurance

Providers submitted an average of $135.61 for this code and Medicare allowed $44.15 — 3.1× 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 $33.16 (75%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $47.15
Hospital / facility: $3.55

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. 6,460 services were billed in an office setting and 477 in a facility.

Services: 6,937
Beneficiaries: 5,388
Providers billing it: 130
Total allowed: $306,269

What Medicare pays for CPT 94690

Across 6,937 services billed by 130 providers to 5,388 beneficiaries, Medicare allowed an average of $44.15 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 94690

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	2,257	2,024	$49.65	39
Pulmonary Disease	1,732	988	$41.16	12
Nurse Practitioner	799	741	$37.94	31
Cardiology	473	232	$41.30	3
Family Practice	421	418	$42.21	23
Pain Management	333	115	$38.70	1
Independent Diagnostic Testing Facility (IDTF)	311	292	$44.15	1
Endocrinology	293	276	$51.13	5
Physician Assistant	144	136	$36.72	7
Gastroenterology	57	57	$56.25	2
General Practice	42	41	$47.56	2
General Surgery	39	37	$51.46	2
Sleep Medicine	20	17	$58.03	1
Advanced Heart Failure and Transplant Cardiology	16	14	$3.56	1

94690 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
Florida	1,187	$45.51	$34.99	14
California	1,034	$55.98	$37.82	4
Mississippi	1,012	$25.39	$22.03	17
New York	1,000	$56.39	$36.41	19
North Carolina	720	$42.20	$34.98	21
Alabama	333	$38.70	$35.19	1
Georgia	260	$44.60	$32.54	6
Maryland	208	$55.19	$36.51	1
Arizona	186	$41.25	$31.42	5
Minnesota	117	$45.06	$31.56	6
Nevada	114	$37.64	$31.82	1
Texas	108	$36.69	$29.13	5
Virginia	91	$31.31	$24.30	5
Oklahoma	80	$37.29	$29.95	4
Pennsylvania	68	$50.19	$37.69	1
Michigan	68	$47.60	$34.77	4
New Jersey	59	$55.46	$36.64	3
South Dakota	57	$3.42	$2.73	1
Louisiana	46	$36.01	$30.48	1
Massachusetts	44	$51.71	$33.28	2
Tennessee	33	$24.51	$21.30	2
South Carolina	27	$33.99	$25.44	1
Illinois	20	$45.72	$34.79	1
Utah	17	$44.68	$38.03	1
Kentucky	13	$31.01	$29.32	1
Wisconsin	12	$3.34	$2.86	1
Ohio	12	$43.77	$33.10	1
Missouri	11	$45.67	$38.10	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
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.