CPT code 94640: Inhalation treatment, acute obstruction or sputum induction2026 Medicare rate & RVUs in Fresno, CA
Reports an inhalation treatment delivered for acute airway obstruction or diagnostic sputum induction, such as nebulized medication for an acute episode.
In Fresno, CA, Medicare pays $9.33 for 94640 in the office.
Check a contract rate as a % of Medicare · 94640 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 94640 covers
This service covers an intermittent inhalation treatment delivered through a nebulizer, aerosol generator, metered-dose inhaler, or similar device to relieve acute airway obstruction or induce sputum for diagnostic testing. A common situation is nebulized bronchodilator treatment for a patient with acute wheezing or an asthma or COPD exacerbation. Physicians, nurses, and respiratory therapists may be involved in delivering the treatment in an office, clinic, or hospital setting.
Report one unit for an episode of care, even when the patient receives multiple inhalation treatments during that episode. For separate episodes on the same date, follow CPT reporting guidance for distinct episodes. Document the clinical reason, device or method, treatment provided, and the patient’s response. When billed as an incident-to service, CMS requires performance under physician supervision.
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.
How Fresno, CA compares for 94640
Across 109 of 109 payment localities, the office rate for 94640 runs from $7.34 in Arkansas to $12.22 in San Benito County, CA. Fresno, CA pays $9.33. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Fresno, CA · this page$9.33
- Bakersfield, CA · California$9.36+$0.03
- Chico, CA · California$9.33
- El Centro, CA · California$9.33
- Hanford, CA · California$9.33
- Los Angeles, CA · California$10.10+$0.77
- Madera, CA · California$9.33
Other areas in California first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| Merced, CACalifornia | $9.33 | — |
| Modesto, CACalifornia | $9.33 | — |
| Napa, CACalifornia | $11.18 | — |
| Oxnard, CACalifornia | $10.08 | — |
| Redding, CACalifornia | $9.33 | — |
| Rest of CaliforniaCalifornia | $9.33 | — |
| Riverside, CACalifornia | $9.44 | — |
| Sacramento, CACalifornia | $9.89 | — |
| Salinas, CACalifornia | $9.86 | — |
| San Diego, CACalifornia | $10.17 | — |
| Marin County, CACalifornia | $11.93 | — |
| San Francisco, CACalifornia | $11.92 | — |
| San Benito County, CACalifornia | $12.22 | — |
| Santa Clara County, CACalifornia | $12.17 | — |
| San Luis Obispo, CACalifornia | $9.69 | — |
| Santa Cruz, CACalifornia | $10.32 | — |
| Santa Maria, CACalifornia | $9.92 | — |
| Santa Rosa, CACalifornia | $10.43 | — |
| Stockton, CACalifornia | $9.33 | — |
| Vallejo, CACalifornia | $11.16 | — |
| Visalia, CACalifornia | $9.33 | — |
| Yuba City, CACalifornia | $9.33 | — |
| Washington, DC areaDistrict of Columbia | $10.21 | — |
| Miami, FLFlorida | $9.54 | — |
| Chicago, ILIllinois | $9.16 | — |
| Manhattan, NYNew York | $10.23 | — |
| AlaskaAlaska | $9.08 | — |
| AlabamaAlabama | $7.50 | — |
| ArkansasArkansas | $7.34 | — |
| ArizonaArizona | $8.38 | — |
| ColoradoColorado | $9.15 | — |
| ConnecticutConnecticut | $9.40 | — |
| DelawareDelaware | $8.55 | — |
| Fort Lauderdale, FLFlorida | $9.06 | — |
| Rest of FloridaFlorida | $8.48 | — |
| Atlanta, GAGeorgia | $8.88 | — |
| Rest of GeorgiaGeorgia | $7.85 | — |
| Hawaii, Guam, HIHawaii | $9.69 | — |
| IowaIowa | $7.77 | — |
| IdahoIdaho | $7.84 | — |
| East St. Louis, ILIllinois | $8.35 | — |
| Rest of IllinoisIllinois | $8.15 | — |
| Suburban Chicago, ILIllinois | $9.17 | — |
| IndianaIndiana | $7.90 | — |
| KansasKansas | $7.72 | — |
| KentuckyKentucky | $7.73 | — |
| New Orleans, LALouisiana | $8.24 | — |
| Rest of LouisianaLouisiana | $7.71 | — |
| Metropolitan Boston, MAMassachusetts | $10.27 | — |
| Rest of MassachusettsMassachusetts | $9.06 | — |
| Baltimore area, MDMaryland | $9.37 | — |
| Rest of MarylandMaryland | $8.76 | — |
| Rest of MaineMaine | $7.89 | — |
| Southern Maine, MEMaine | $8.49 | — |
| Detroit, MIMichigan | $8.62 | — |
| Rest of MichiganMichigan | $8.00 | — |
| MinnesotaMinnesota | $8.69 | — |
| Metropolitan Kansas City, MOMissouri | $8.17 | — |
| Metropolitan St. Louis, MOMissouri | $8.28 | — |
| Rest of MissouriMissouri | $7.52 | — |
| MississippiMississippi | $7.44 | — |
| MontanaMontana | $8.68 | — |
| North CarolinaNorth Carolina | $8.00 | — |
| North DakotaNorth Dakota | $8.49 | — |
| NebraskaNebraska | $7.83 | — |
| New HampshireNew Hampshire | $8.98 | — |
| Northern New JerseyNew Jersey | $10.04 | — |
| Rest of New JerseyNew Jersey | $9.48 | — |
| New MexicoNew Mexico | $8.06 | — |
| NevadaNevada | $8.64 | — |
| NYC suburbs and Long Island, NYNew York | $10.55 | — |
| Poughkeepsie and northern NYC suburbs, NYNew York | $9.55 | — |
| Queens, NYNew York | $10.35 | — |
| Rest of New YorkNew York | $8.17 | — |
| OhioOhio | $7.96 | — |
| OklahomaOklahoma | $7.72 | — |
| Portland, OROregon | $9.53 | — |
| Rest of OregonOregon | $8.55 | — |
| Metropolitan Philadelphia, PAPennsylvania | $9.09 | — |
| Rest of PennsylvaniaPennsylvania | $7.98 | — |
| Puerto RicoPuerto Rico | $8.77 | — |
| Rhode IslandRhode Island | $8.92 | — |
| South CarolinaSouth Carolina | $8.00 | — |
| South DakotaSouth Dakota | $8.46 | — |
| TennesseeTennessee | $7.77 | — |
| Austin, TXTexas | $9.13 | — |
| Beaumont, TXTexas | $7.91 | — |
| Brazoria, TXTexas | $8.54 | — |
| Dallas, TXTexas | $8.60 | — |
| Fort Worth, TXTexas | $8.52 | — |
| Galveston, TXTexas | $8.57 | — |
| Houston, TXTexas | $8.75 | — |
| Rest of TexasTexas | $8.23 | — |
| UtahUtah | $8.15 | — |
| VirginiaVirginia | $8.44 | — |
| Virgin Islands, VIUnited States Virgin Islands | $8.77 | — |
| VermontVermont | $8.44 | — |
| Rest of WashingtonWashington | $9.05 | — |
| King County, WAWashington | $10.52 | — |
| WisconsinWisconsin | $8.10 | — |
| West VirginiaWest Virginia | $7.73 | — |
| WyomingWyoming | $8.60 | — |
94640 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$7.34
$10.78
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $9.08 | 1 |
| AL | $7.50 | 1 |
| AR | $7.34 | 1 |
| AZ | $8.38 | 1 |
| CA | $9.33–$12.22 | 29 |
| CO | $9.15 | 1 |
| CT | $9.40 | 1 |
| DC | $10.21 | 1 |
| DE | $8.55 | 1 |
| FL | $8.48–$9.54 | 3 |
| GA | $7.85–$8.88 | 2 |
| GU | $9.69 | 1 |
| HI | $9.69 | 1 |
| IA | $7.77 | 1 |
| ID | $7.84 | 1 |
| IL | $8.15–$9.17 | 4 |
| IN | $7.90 | 1 |
| KS | $7.72 | 1 |
| KY | $7.73 | 1 |
| LA | $7.71–$8.24 | 2 |
| MA | $9.06–$10.27 | 2 |
| MD | $8.76–$10.21 | 3 |
| ME | $7.89–$8.49 | 2 |
| MI | $8.00–$8.62 | 2 |
| MN | $8.69 | 1 |
| MO | $7.52–$8.28 | 3 |
| MS | $7.44 | 1 |
| MT | $8.68 | 1 |
| NC | $8.00 | 1 |
| ND | $8.49 | 1 |
| NE | $7.83 | 1 |
| NH | $8.98 | 1 |
| NJ | $9.48–$10.04 | 2 |
| NM | $8.06 | 1 |
| NV | $8.64 | 1 |
| NY | $8.17–$10.55 | 5 |
| OH | $7.96 | 1 |
| OK | $7.72 | 1 |
| OR | $8.55–$9.53 | 2 |
| PA | $7.98–$9.09 | 2 |
| PR | $8.77 | 1 |
| RI | $8.92 | 1 |
| SC | $8.00 | 1 |
| SD | $8.46 | 1 |
| TN | $7.77 | 1 |
| TX | $7.91–$9.13 | 8 |
| UT | $8.15 | 1 |
| VA | $8.44–$10.21 | 2 |
| VI | $8.77 | 1 |
| VT | $8.44 | 1 |
| WA | $9.05–$10.52 | 2 |
| WI | $8.10 | 1 |
| WV | $7.73 | 1 |
| WY | $8.60 | 1 |
How the 94640 rate is calculated
Each of 94640’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 · 94640
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.25
0.25 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
0.2600
Conversion factor
$33.4009
Medicare rate
$8.68
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Fresno, CA inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
12,412
- Code
- 94640
- Physician work
- 0.00
- Practice expense
- 0.25
- Malpractice
- 0.01
GPCI2026.csv
11
- Locality
- Fresno, CA
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.00 | × 1.017 | 0.0000 |
| Practice expense | 0.25 | × 1.096 | 0.2740 |
| Malpractice | 0.01 | × 0.536 | 0.0054 |
| Total RVUs | 0.2794 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Fresno, CA$9.33
Office: (0 × 1.017 + 0.25 × 1.096 + 0.01 × 0.536) × $33.4009 = $9.33
Payment rules and modifiers for 94640
The CMS indicators that decide how 94640 is paid alongside other services.
CMS payment indicators · 94640
Inhalation treatment, acute obstruction or sputum induction
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 5 | Incident-to service. |
How 94640 has changed in Fresno, CA
94640 · Office / nonfacility
$9.33
Effective 2026-10-01
The base rate is $1.02 higher than on 2025-10-01, moving from $8.31 to $9.33 (12.3%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$8.31changed to$9.33
- Conversion factor 32.3465 changed to 33.4009
- Practice expense RVU 0.23 changed to 0.25
- Work GPCI 1.014 changed to 1.017
- Practice expense GPCI 1.093 changed to 1.096
- Malpractice GPCI 0.560 changed to 0.536
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$8.55changed to$8.31
- Conversion factor 33.2875 changed to 32.3465
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$8.41changed to$8.55
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$9.70changed to$8.41
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 0.26 changed to 0.23
- Work GPCI 1.021 changed to 1.014
- Practice expense GPCI 1.079 changed to 1.093
- Malpractice GPCI 0.579 changed to 0.560
January 1, 2023
RVU23A
$12.00changed to$9.70
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 0.32 changed to 0.26
- Work GPCI 1.027 changed to 1.021
- Practice expense GPCI 1.065 changed to 1.079
- Malpractice GPCI 0.597 changed to 0.579
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$15.07changed to$12.00
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 0.40 changed to 0.32
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$19.13changed to$15.07
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 0.49 changed to 0.40
- Work GPCI 1.024 changed to 1.027
- Practice expense GPCI 1.070 changed to 1.065
- Malpractice GPCI 0.580 changed to 0.597
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$19.56changed to$19.13
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 0.50 changed to 0.49
- Work GPCI 1.020 changed to 1.024
- Practice expense GPCI 1.074 changed to 1.070
- Malpractice GPCI 0.562 changed to 0.580
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$20.31changed to$19.56
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 0.52 changed to 0.50
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$19.97changed to$20.31
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 0.51 changed to 0.52
- Work GPCI 1.024 changed to 1.020
- Practice expense GPCI 1.079 changed to 1.074
- Malpractice GPCI 0.610 changed to 0.562
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
No ratechanged to$19.97
Held through RVU17B, RVU17C, RVU17D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $9.33 | Not available in this setting | RVU26D |
| 2026-07-01 | $9.33 | Not available in this setting | RVU26C |
| 2026-04-01 | $9.33 | Not available in this setting | RVU26B |
| 2026-01-01 | $9.33 | Not available in this setting | RVU26A |
| 2025-10-01 | $8.31 | Not available in this setting | RVU25D |
| 2025-07-01 | $8.31 | Not available in this setting | RVU25C |
| 2025-04-01 | $8.31 | Not available in this setting | RVU25B |
| 2025-01-01 | $8.31 | Not available in this setting | RVU25A |
| 2024-10-01 | $8.55 | Not available in this setting | RVU24D |
| 2024-07-01 | $8.55 | Not available in this setting | RVU24C |
| 2024-04-01 | $8.55 | Not available in this setting | RVU24B |
| 2024-03-09 | $8.55 | Not available in this setting | RVU24AR |
| 2024-01-01 | $8.41 | Not available in this setting | RVU24A |
| 2023-10-01 | $9.70 | Not available in this setting | RVU23D |
| 2023-07-01 | $9.70 | Not available in this setting | RVU23C |
| 2023-04-01 | $9.70 | Not available in this setting | RVU23B |
| 2023-01-01 | $9.70 | Not available in this setting | RVU23A |
| 2022-10-01 | $12.00 | Not available in this setting | RVU22D |
| 2022-07-01 | $12.00 | Not available in this setting | RVU22C |
| 2022-04-01 | $12.00 | Not available in this setting | RVU22B |
| 2022-01-01 | $12.00 | Not available in this setting | RVU22A |
| 2021-10-01 | $15.07 | Not available in this setting | RVU21D |
| 2021-07-01 | $15.07 | Not available in this setting | RVU21C |
| 2021-04-01 | $15.07 | Not available in this setting | RVU21B |
| 2021-01-01 | $15.07 | Not available in this setting | RVU21A |
| 2020-10-01 | $19.13 | Not available in this setting | RVU20D |
| 2020-07-01 | $19.13 | Not available in this setting | RVU20C |
| 2020-04-01 | $19.13 | Not available in this setting | RVU20B |
| 2020-01-01 | $19.13 | Not available in this setting | RVU20A |
| 2019-10-01 | $19.56 | Not available in this setting | RVU19D |
| 2019-07-01 | $19.56 | Not available in this setting | RVU19C |
| 2019-04-01 | $19.56 | Not available in this setting | RVU19B |
| 2019-01-01 | $19.56 | Not available in this setting | RVU19A |
| 2018-10-01 | $20.31 | Not available in this setting | RVU18D |
| 2018-07-01 | $20.31 | Not available in this setting | RVU18C |
| 2018-04-01 | $20.31 | Not available in this setting | RVU18B |
| 2018-01-01 | $20.31 | Not available in this setting | RVU18AR1 |
| 2017-10-01 | $19.97 | Not available in this setting | RVU17D |
| 2017-07-01 | $19.97 | Not available in this setting | RVU17C |
| 2017-04-01 | $19.97 | Not available in this setting | RVU17B |
| 2017-01-01 | $19.97 | Not available in this setting | RVU17A |
| 2016-10-01 | Rate data unavailable | Not available in this setting | RVU16D |
| 2016-07-01 | Rate data unavailable | Not available in this setting | RVU16C |
| 2016-04-01 | Rate data unavailable | Not available in this setting | RVU16B |
| 2016-01-01 | Rate data unavailable | Not available in this setting | RVU16A |
| 2015-10-01 | Rate data unavailable | Not available in this setting | RVU15D |
| 2015-07-01 | Rate data unavailable | Not available in this setting | RVU15C |
| 2015-04-01 | Rate data unavailable | Not available in this setting | RVU15B |
| 2015-01-01 | Rate data unavailable | Not available in this setting | RVU15A |
| 2014-10-01 | Rate data unavailable | Not available in this setting | RVU14D |
| 2014-07-01 | Rate data unavailable | Not available in this setting | RVU14C |
| 2014-04-01 | Rate data unavailable | Not available in this setting | RVU14B |
| 2014-01-01 | Rate data unavailable | Not available in this setting | RVU14A |
| 2013-10-01 | Rate data unavailable | Not available in this setting | RVU13D |
| 2013-07-01 | Rate data unavailable | Not available in this setting | RVU13C |
| 2013-04-01 | Rate data unavailable | Not available in this setting | RVU13B |
| 2013-01-01 | Rate data unavailable | Not available in this setting | RVU13AR |
Where the Fresno, CA rate applies
Fresno, CA is a Medicare payment area, not a city. Our Census mapping connects it to 45 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.
- Fresno
- Auberry
- Big Creek
- Biola
- Bowles
- Calwa
- Cantua Creek
- Caruthers
94640 billing questions
Is 94640 reported for every nebulizer treatment?
No. Report one unit for the episode of care, regardless of the number of inhalation treatments provided during that episode. Distinct episodes on the same date are subject to CPT reporting guidance.
When is 94640 preferable to continuous inhalation treatment?
Use 94640 for an intermittent treatment for acute airway obstruction or diagnostic sputum induction. Code 94644 describes continuous inhalation treatment, with 94645 for each additional hour.
Can a nurse or respiratory therapist provide the service?
They may be involved in delivering it. When the service is billed as incident-to, it must be performed under physician supervision.
What documentation supports 94640?
Document the acute obstruction or diagnostic sputum-induction purpose, the treatment and delivery method, and the patient’s response. The record should support the reported episode of care.
Is inhaler instruction part of 94640?
No. 94640 represents treatment delivery, while 94664 is for demonstrating or evaluating the patient’s use of an inhalation device. Report the latter only when that distinct teaching or evaluation service is performed and supported.
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
Show the CMS file lines behind this rate
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