How much does Medicare pay for CPT 94726?

Medicare allowed an average of $34.10 per service and paid $26.07 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $115.60, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 94726?

Test to determine lung volumes using sensors. It was billed 622,345 times to 591,491 Medicare beneficiaries by 6,789 providers in 2024.

Does 94726 pay differently in an office than a hospital?

Yes. The allowed amount averaged $50.62 in an office setting and $11.53 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 94726 most?

Pulmonary Disease, with 483,154 services from 4,979 clinicians. Next are Internal Medicine, Critical Care (Intensivists), Nurse Practitioner.

CPT 94726

Test to determine lung volumes using sensors

$34.10Medicare-allowed amount per service, averaged across 622,345 services

Providers submitted

$115.60

Asking price, not received

Medicare allowed

$34.10

The fee schedule figure

Medicare paid

$26.07

Balance is patient coinsurance

Providers submitted an average of $115.60 for this code and Medicare allowed $34.10 — 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 $26.07 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $50.62
Hospital / facility: $11.53

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. 359,402 services were billed in an office setting and 262,943 in a facility.

Services: 622,345
Beneficiaries: 591,491
Providers billing it: 6,789
Total allowed: $21,221,965

What Medicare pays for CPT 94726

Across 622,345 services billed by 6,789 providers to 591,491 beneficiaries, Medicare allowed an average of $34.10 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 94726

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pulmonary Disease	483,154	461,041	$33.85	4,979
Internal Medicine	54,862	51,854	$35.42	669
Critical Care (Intensivists)	48,798	47,113	$31.88	666
Nurse Practitioner	11,787	10,669	$39.36	160
Allergy/ Immunology	6,094	5,458	$46.75	96
Sleep Medicine	3,340	3,293	$23.93	40
Physician Assistant	3,283	3,132	$36.92	53
Cardiology	2,939	1,798	$26.85	27
Hospitalist	1,566	1,553	$17.66	35
General Practice	1,290	1,122	$60.70	2
Family Practice	1,121	865	$48.46	16
Advanced Heart Failure and Transplant Cardiology	797	412	$33.59	4
Independent Diagnostic Testing Facility (IDTF)	789	759	$48.60	9
Anesthesiology	425	375	$53.02	2
Obstetrics & Gynecology	385	373	$58.80	1

94726 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	53,391	$43.38	$29.00	516
Florida	49,532	$42.89	$33.83	400
Texas	49,342	$39.01	$31.09	460
New York	42,066	$50.16	$33.78	413
Illinois	32,500	$26.61	$20.11	319
Pennsylvania	26,829	$21.30	$16.26	350
North Carolina	22,814	$38.62	$31.11	230
Virginia	20,372	$34.47	$26.11	201
Ohio	19,669	$19.87	$15.73	292
Arizona	19,449	$43.19	$33.51	139
Michigan	18,321	$26.75	$20.56	269
Missouri	16,736	$21.74	$17.29	177
Georgia	16,461	$43.91	$35.06	248
New Jersey	14,006	$48.28	$33.33	177
Massachusetts	13,340	$21.03	$14.85	192
Indiana	12,982	$20.21	$16.16	173
South Carolina	12,770	$37.65	$30.94	138
Maryland	12,184	$45.49	$32.89	108
Kentucky	12,155	$24.68	$20.51	160
Washington	11,628	$34.82	$24.89	155
Tennessee	11,525	$31.54	$26.74	131
Minnesota	10,961	$36.44	$27.42	112
Wisconsin	9,990	$21.44	$16.93	143
Kansas	8,531	$29.26	$23.98	76
Mississippi	8,370	$33.25	$29.43	73
Colorado	7,399	$24.83	$18.47	104
Alabama	6,520	$38.08	$32.39	69
Arkansas	6,394	$21.64	$18.45	49
Nebraska	6,109	$31.06	$25.15	56
Oklahoma	6,071	$21.91	$18.45	73
Iowa	5,949	$15.10	$12.16	65
Oregon	5,673	$22.18	$16.62	78
Louisiana	5,460	$23.90	$19.77	79
Delaware	5,130	$31.16	$23.66	26
Nevada	4,838	$38.80	$30.65	43
Idaho	3,836	$12.72	$9.63	41
New Hampshire	3,747	$15.49	$11.59	42
New Mexico	3,684	$32.57	$27.05	36
West Virginia	3,446	$24.86	$20.36	50
Connecticut	3,367	$31.95	$22.64	73
South Dakota	2,578	$14.30	$10.81	23
Montana	2,425	$20.89	$15.73	30
Maine	2,283	$17.39	$12.92	36
North Dakota	2,036	$13.35	$10.24	23
District of Columbia	1,900	$46.31	$31.95	27
Utah	1,891	$26.60	$20.87	30
Rhode Island	1,705	$42.33	$29.92	24
Vermont	1,328	$20.33	$15.69	14
Alaska	1,213	$21.80	$13.06	18
Hawaii	742	$19.36	$13.99	14
Wyoming	353	$12.91	$9.68	5
Puerto Rico	177	$54.55	$42.83	8
Guam	167	$11.98	$8.43	1

Related codes

94729Test to examine how well the lungs exchange gases$34.47
94727Test to determine lung volumes$35.30
94762Test to measure oxygen level in blood$29.99
94760Test to measure oxygen level in blood$2.51
94728Test to measure resistance of the airways and lungs to differing frequ$40.57
94761Test to measure oxygen level in blood$4.63

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.