How much does Medicare pay for CPT 94727?

Medicare allowed an average of $35.30 per service and paid $27.12 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $104.21, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 94727?

Test to determine lung volumes using gas dilution or washout. It was billed 237,038 times to 223,545 Medicare beneficiaries by 2,786 providers in 2024.

Does 94727 pay differently in an office than a hospital?

Yes. The allowed amount averaged $43.03 in an office setting and $11.62 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 94727 most?

Pulmonary Disease, with 178,089 services from 1,974 clinicians. Next are Internal Medicine, Critical Care (Intensivists), Nurse Practitioner.

CPT 94727

Test to determine lung volumes using gas dilution or washout

$35.30Medicare-allowed amount per service, averaged across 237,038 services

Providers submitted

$104.21

Asking price, not received

Medicare allowed

$35.30

The fee schedule figure

Medicare paid

$27.12

Balance is patient coinsurance

Providers submitted an average of $104.21 for this code and Medicare allowed $35.30 — 3.0× 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 $27.12 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $43.03
Hospital / facility: $11.62

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. 178,753 services were billed in an office setting and 58,285 in a facility.

Services: 237,038
Beneficiaries: 223,545
Providers billing it: 2,786
Total allowed: $8,367,441

What Medicare pays for CPT 94727

Across 237,038 services billed by 2,786 providers to 223,545 beneficiaries, Medicare allowed an average of $35.30 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 94727

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pulmonary Disease	178,089	167,835	$35.28	1,974
Internal Medicine	27,516	25,906	$36.15	347
Critical Care (Intensivists)	15,057	14,286	$31.37	216
Nurse Practitioner	4,956	4,757	$35.28	86
Allergy/ Immunology	1,876	1,742	$32.83	24
Family Practice	1,652	1,570	$43.29	38
Cardiology	1,425	1,343	$44.50	25
Hospitalist	1,210	1,196	$37.89	11
Sleep Medicine	1,012	938	$30.61	15
General Practice	897	752	$47.87	4
Physician Assistant	831	812	$32.67	18
Independent Diagnostic Testing Facility (IDTF)	709	681	$36.20	2
Interventional Cardiology	425	411	$41.60	4
Emergency Medicine	393	391	$46.09	4
Undefined Physician type	203	198	$52.27	1

94727 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	32,408	$38.03	$29.58	312
New York	32,021	$45.75	$30.47	299
New Jersey	20,110	$39.92	$27.54	221
California	15,760	$40.98	$27.81	172
Maryland	12,109	$36.46	$26.29	89
Alabama	9,526	$31.36	$26.92	95
Texas	9,245	$32.33	$25.93	129
Pennsylvania	9,115	$32.78	$25.33	152
Georgia	8,807	$34.30	$27.76	91
Virginia	7,554	$43.46	$31.73	67
Massachusetts	7,443	$19.90	$14.13	114
Tennessee	7,322	$32.05	$27.16	109
Connecticut	6,222	$32.74	$23.27	96
Ohio	5,449	$19.28	$15.32	82
Arizona	5,133	$32.56	$26.07	43
Indiana	5,118	$25.49	$20.68	58
North Carolina	4,611	$32.98	$26.95	60
Michigan	4,319	$38.88	$30.60	54
Arkansas	3,030	$28.91	$25.31	20
Louisiana	2,841	$19.30	$15.89	39
Illinois	2,727	$27.22	$21.24	49
Colorado	2,545	$38.78	$28.54	48
Utah	2,312	$17.00	$13.32	21
Mississippi	2,143	$28.64	$25.09	21
Oklahoma	1,968	$24.36	$19.81	21
Missouri	1,644	$20.40	$16.51	30
Puerto Rico	1,535	$42.77	$33.19	31
South Carolina	1,498	$35.28	$28.49	17
Nevada	1,465	$37.98	$30.44	13
Kentucky	1,310	$28.38	$23.91	27
Iowa	1,209	$31.96	$26.08	17
Washington	1,195	$35.70	$25.87	31
West Virginia	1,068	$16.59	$12.69	10
Rhode Island	1,055	$22.24	$16.93	19
Minnesota	816	$22.80	$16.92	21
Kansas	752	$20.07	$16.25	18
Delaware	671	$20.30	$15.88	10
New Hampshire	607	$14.89	$11.24	10
Oregon	406	$33.32	$25.85	15
Wisconsin	332	$14.14	$10.74	12
District of Columbia	292	$20.00	$13.84	13
Alaska	262	$46.28	$31.35	4
South Dakota	193	$11.33	$8.60	1
Maine	190	$14.95	$11.19	5
New Mexico	178	$28.98	$23.77	8
Nebraska	161	$12.27	$8.26	1
Hawaii	115	$11.50	$8.55	4
Montana	98	$38.90	$28.47	3
U.S. Virgin Islands	56	$44.11	$34.04	1
Guam	49	$11.87	$9.01	1
Idaho	43	$11.79	$8.47	2

Related codes

94729Test to examine how well the lungs exchange gases$34.47
94726Test to determine lung volumes$34.10
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.