CPT code 94642: Pentamidine treatment, each treatment2026 Medicare rate & RVUs in Michigan
Reports an inhaled pentamidine treatment, commonly used to prevent Pneumocystis pneumonia in immunocompromised patients receiving respiratory care.
CMS doesn’t publish an office rate for 94642 in Michigan.
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 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 in Michigan
| Payment locality | Office | Facility |
|---|---|---|
| Detroit, MI | Unavailable | Unavailable |
| Rest of Michigan | Unavailable | Unavailable |
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
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
| 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. |
94642 compared with similar codes
Compare codes · National
5 codes, side by side
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.
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
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