CPT code 94626: Pulmonary rehab, with continuous oximetry2026 Medicare rate & RVUs in Illinois
Report this service for an outpatient pulmonary rehabilitation session delivered by a physician or qualified health care professional with continuous oximetry monitoring.
Medicare pays $102.87–$113.54 for 94626 in the office in Illinois, from Rest of Illinois to Suburban Chicago, IL. 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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On this page 9 sections
What 94626 covers
This service covers a session of outpatient pulmonary rehabilitation that includes continuous oximetry monitoring. It is used for patients with chronic respiratory disease who need structured rehabilitation, commonly people with COPD working to improve exercise tolerance and manage breathlessness. A physician or other qualified health care professional provides the service; rehabilitation staff may support exercise and other session activities. The oximetry monitors oxygen saturation continuously during the session, rather than only at selected points.
Report one unit for the rehabilitation session, not for each exercise or monitoring interval. Documentation should identify the patient’s pulmonary rehabilitation session, the services performed, and the continuous oximetry monitoring. Code 94625 is the sibling option when the session is performed without continuous oximetry. Continuous monitoring distinguishes 94626 from that code; it is not an additional service to report separately from the session code.
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 94626 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$102.87 to $113.54
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | $112.82 | $27.56 |
| East St. Louis, IL | $104.54 | $26.49 |
| Rest of Illinois | $102.87 | $25.41 |
| Suburban Chicago, IL | $113.54 | $26.41 |
How the 94626 rate is calculated
Each of 94626’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 · 94626
RVUs × geographic indexes × conversion factor
Work0.56
0.56 RVUs× 1.000 GPCI
Practice expense2.64
2.64 RVUs× 1.000 GPCI
Malpractice0.07
0.07 RVUs× 1.000 GPCI
Adjusted RVUs
3.2700
Conversion factor
$33.4009
Medicare rate
$109.22
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 94626
94626 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 · 94626
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$109.22
- Non-facility (office)
- $109.22
- Facility
- $24.38
Higher because the practice carries its own overhead.
94626 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 94625Pulmonary rehabWithout continuous ECG monitoring
- Choose 94626 when the pulmonary rehabilitation session includes continuous oximetry; 94625 describes the session without that monitoring.
- 94618Pulmonary stress testSimple exercise assessment
- 94618 reports pulmonary stress testing to assess exercise response. It is not a session of ongoing outpatient pulmonary rehabilitation.
- 94621Exercise testCardiopulmonary gas analysis
- 94621 is cardiopulmonary exercise testing, a diagnostic assessment of exercise capacity; 94626 is a pulmonary rehabilitation session with continuous oximetry.
94626 billing questions
How does 94626 differ from 94625?
94626 is for an outpatient pulmonary rehabilitation session with continuous oximetry. Use 94625 when the session does not include continuous oximetry.
Is the code reported per session or per exercise?
Report one unit for the rehabilitation session. Do not count individual exercises or monitoring intervals as separate units.
Can continuous oximetry be billed separately from 94626?
Continuous oximetry is the distinguishing element of 94626, not a separate add-on service to report for that session.
What documentation supports reporting 94626?
Document the outpatient pulmonary rehabilitation session, the services performed, and continuous oximetry monitoring during the session.
Is 94626 a pulmonary exercise stress test?
No. It reports a rehabilitation session. Codes such as 94618 describe pulmonary stress testing to assess exercise response, not a rehabilitation session.
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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