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CPT code 94642: Pentamidine treatment, each treatment2026 Medicare rate & RVUs

Reports an inhaled pentamidine treatment, commonly used to prevent Pneumocystis pneumonia in immunocompromised patients receiving respiratory care.

CMS RVU26DEffective Oct 1, 2026109 payment localities1.8K Medicare services in 2024

Medicare rate · 94642

Pentamidine treatment, each treatment

Office or facility?

Work RVUs
0
Total RVUs
0.00
Global days
XXX

National rate · 2026

—

Not priced in the facility setting.

See every locality for 94642 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 94642 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 94642 covers

This code describes administering pentamidine by aerosol inhalation, generally for prevention of Pneumocystis pneumonia in immunocompromised patients. A respiratory therapist or other clinical staff member may deliver the treatment in an outpatient setting using a nebulizer suited to aerosolized pentamidine. It represents the treatment session, not routine nebulized bronchodilator therapy or instruction in inhaler use.

Medicare assigns this CPT code status C, or carrier priced: CMS publishes no national payment, and the Medicare Administrative Contractor sets payment for each claim. The service is billed only when performed under physician supervision. Report one unit for each treatment session. The medication may have a separate drug code when applicable; 94642 describes the inhalation treatment itself.

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 94642 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

94642 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailableUnavailable
AlaskaUnavailableUnavailable
ArizonaUnavailableUnavailable
ArkansasUnavailableUnavailable
Atlanta, GAUnavailableUnavailable
Austin, TXUnavailableUnavailable
Bakersfield, CAUnavailableUnavailable
Baltimore area, MDUnavailableUnavailable
Beaumont, TXUnavailableUnavailable
Brazoria, TXUnavailableUnavailable

94642 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

View every state and territory as a table
94642 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 94642 rate is calculated

Each of 94642’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 · 94642

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.00

0.00 RVUs× 1.000 GPCI

Practice expense0.00

0.00 RVUs× 1.000 GPCI

Malpractice0.00

0.00 RVUs× 1.000 GPCI

Adjusted RVUs

0.0000

Conversion factor

$33.4009

Medicare rate

$0.00

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 94642

The CMS indicators that decide how 94642 is paid alongside other services.

CMS payment indicators · 94642

Pentamidine treatment, each treatment

RuleCMS valueWhat it means
Global periodXXXThe global surgery concept doesn’t apply.
Multiple procedures0No multiple-procedure reduction.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical5Incident-to service.

94642 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 94642

    Pentamidine treatment, each treatment0 wRVU

    Not priced

  • 94640

    Inhalation treatment, acute obstruction or sputum induction0 wRVU

    $8.68

  • 94644

    Continuous inhalation, first hour0 wRVU

    $62.46

  • 94645

    Continuous inhalation, each additional hour0 wRVU

    $16.70

  • J2545

    Inhaled pentamidine, per 300 mg0 wRVU

    Not priced

How to choose

94640Inhalation treatmentAcute obstruction or sputum induction
94642 is specific to aerosolized pentamidine. Use 94640 for other inhalation treatments, including acute airway obstruction treatment or sputum induction.
94644Continuous inhalationFirst hour
94644 describes continuous inhalation treatment during the first hour. It is not the code for a pentamidine treatment session.
94645Continuous inhalationEach additional hour
94645 describes each additional hour of continuous inhalation treatment after the initial hour; 94642 reports a pentamidine treatment session.
J2545Inhaled pentamidinePer 300 mg
J2545 identifies pentamidine isethionate as a drug. Code 94642 describes administering the medication by aerosol inhalation.

Codes related to 94642

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 94642
CodeHow it relatesNational office range
Often billed with
J2545Inhaled pentamidine, per 300 mgDrug code for pentamidine isethionate; may accompany the inhalation treatment when the medication is reported.No office rate
Used instead
94640Inhalation treatment, acute obstruction or sputum inductionFor other inhalation treatments, including acute airway obstruction treatment or diagnostic sputum induction.$7.34–$12.22
94644Continuous inhalation, first hourDescribes continuous inhalation treatment by time, rather than a pentamidine treatment session.$53.42–$89.46

94642 billing questions

When should 94642 be used instead of 94640?

Use 94642 for aerosolized pentamidine treatment. Code 94640 describes other inhalation treatments, such as treatment for acute airway obstruction or sputum induction.

How many units are reported for a treatment session?

Report one unit for each pentamidine inhalation treatment session.

Does 94642 include the pentamidine medication?

94642 describes the inhalation treatment. Report the drug separately under an applicable drug code when appropriate.

What supervision is required for Medicare billing?

The service may be billed only when performed under physician supervision.

How does Medicare price 94642?

It has physician fee schedule status C. CMS publishes no national payment; the Medicare Administrative Contractor sets payment for each claim.

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

Open CMS sourceHow we calculate rates

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