CPT code 94625: Pulmonary rehab, without continuous ECG monitoring2026 Medicare rate & RVUs in New York
A physician or qualified health care professional reports this code for an outpatient pulmonary rehabilitation session conducted without continuous ECG monitoring.
Medicare pays $83.01–$103.27 for 94625 in the office in New York, from Rest of New York to NYC suburbs and Long Island, NY. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 94625 covers
94625 represents one outpatient pulmonary rehabilitation session delivered by a physician or other qualified health care professional without continuous ECG monitoring. These sessions are part of structured rehabilitation for people with chronic pulmonary disease, such as COPD, and may include individualized physical conditioning and disease-management education. The service is rehabilitation, not a diagnostic exercise stress test or a stand-alone inhaler demonstration.
Report one unit for the session, selecting 94625 when continuous ECG monitoring is not used; use 94626 for a session with continuous ECG monitoring. Documentation should identify the pulmonary rehabilitation session, activities provided, and monitoring approach. CMS assigns separate office and facility practice-expense inputs in the physician fee schedule, so the setting affects the fee-schedule valuation used for the service.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 94625 pays more and less in New York
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
5 payment localities
$83.01 to $103.27
| Payment locality | Office | Facility |
|---|---|---|
| Manhattan, NY | $100.83 | $18.55 |
| NYC suburbs and Long Island, NY | $103.27 | $19.07 |
| Poughkeepsie and northern NYC suburbs, NY | $95.05 | $17.51 |
| Queens, NY | $102.06 | $18.36 |
| Rest of New York | $83.01 | $15.74 |
How the 94625 rate is calculated
Each of 94625’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 94625
RVUs × geographic indexes × conversion factor
Work0.36
0.36 RVUs× 1.000 GPCI
Practice expense2.20
2.20 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
2.6100
Conversion factor
$33.4009
Medicare rate
$87.18
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 94625
94625 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 94625
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$87.18
- Non-facility (office)
- $87.18
- Facility
- $16.37
Higher because the practice carries its own overhead.
94625 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 94626Pulmonary rehabWith continuous oximetry
- Both describe outpatient pulmonary rehabilitation sessions. The distinguishing feature is continuous ECG monitoring, which is included in 94626.
- 94618Pulmonary stress testSimple exercise assessment
- 94618 describes a simple pulmonary stress test, commonly used to assess exercise-related function. 94625 describes a rehabilitation session, not a diagnostic test.
- 94621Exercise testCardiopulmonary gas analysis
- 94621 is cardiopulmonary exercise testing for diagnostic assessment. Choose 94625 for a pulmonary rehabilitation session without continuous ECG monitoring.
94625 billing questions
When should 94625 be chosen over 94626?
Use 94625 for an outpatient pulmonary rehabilitation session without continuous ECG monitoring. Use 94626 when continuous ECG monitoring is part of the session.
Is 94625 reported per exercise or per session?
Report one unit for the pulmonary rehabilitation session, not a separate unit for each exercise performed during it.
Does 94625 cover a diagnostic exercise test?
No. It represents a rehabilitation session. A simple pulmonary stress test or cardiopulmonary exercise test is reported with the applicable testing code, such as 94618 or 94621.
What should the note support?
Document the outpatient pulmonary rehabilitation session, the rehabilitation activities provided, and whether continuous ECG monitoring was used.
Can inhaler instruction be reported with 94625?
94625 describes the rehabilitation session, not a separate inhaler demonstration. If inhaler instruction is provided as a distinct service, consider whether 94664 accurately describes that service and check applicable claim edits.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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