No office rate
94002 covers the initial day of inpatient or observation management using a pressure- or volume-preset ventilator. Code 94004 concerns noninvasive ventilation for acute respiratory failure.
On this page
CMS RVU26D · Effective 2026-10-01
94004 Ventilation management Medicare reimbursement rates in Delaware
Reports daily physician management of noninvasive ventilatory support, such as CPAP or bilevel ventilation, for a patient with acute respiratory failure. Compare 94004 office and facility rates across CMS payment localities in Delaware.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 94004 in Delaware?
Delaware has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$43.59
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Pulmonary medicine
About 94004: Noninvasive ventilation management for acute respiratory failure
Reports daily physician management of noninvasive ventilatory support, such as CPAP or bilevel ventilation, for a patient with acute respiratory failure.
CPT 94004 represents a day of physician management of noninvasive ventilatory support for acute respiratory failure. The support may use continuous positive airway pressure or bilevel positive airway pressure through a mask rather than an endotracheal tube or tracheostomy. Pulmonary and critical care physicians commonly provide this service in an acute-care setting when they assess and manage a patient's respiratory support and response.
Choose this code for the acute respiratory failure and noninvasive ventilation management service, not for invasive ventilator management or routine home ventilator oversight. The record should identify the acute respiratory failure, the noninvasive support being managed, and the physician's assessment and management for that date. Report the service by day, rather than by hour or ventilator adjustment. CMS lists this as a physician fee schedule service; no additional payment rule is specified in the supplied CMS facts.
Where the value comes from
- Work RVU1.00 · 76%
- Practice expense (office) RVU0.24 · 18%
- Malpractice RVU0.07 · 5%
17.4K
Medicare services in 2024 · #1200 by national volume
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.
94004 compared with similar codes
Office rates for Delaware, from the same CMS release.
No office rate
94003 is for a subsequent inpatient or observation day managing a pressure- or volume-preset ventilator. Code 94004 describes daily management of noninvasive ventilation for acute respiratory failure.
94005
No office rateHome vent mgmt supervision
94005 is associated with home ventilator management. Use 94004 for daily management of noninvasive ventilation in acute respiratory failure.
$68.55
94660 describes CPAP ventilation initiation and management. Code 94004 is specific to daily noninvasive ventilation management for acute respiratory failure.
Compare 94004 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Delaware →
Office / nonfacility
Unavailable
Facility
$43.59
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 94004 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
12,362
- Code
- 94004
- Physician work
- 1.00
- Practice expense
- 0.24
- Malpractice
- 0.07
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.00 | × 1.005 | 1.0050 |
| Practice expense | 0.24 | × 0.988 | 0.2371 |
| Malpractice | 0.07 | × 0.899 | 0.0629 |
| Total RVUs | 1.3050 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$43.59
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1 | 1.005 |
| Practice expense | 0.24 | 0.988 |
| Malpractice | 0.07 | 0.899 |
(1 × 1.005 + 0.24 × 0.988 + 0.07 × 0.899) × $33.4009 = $43.59
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
94004 billing questions
How does 94004 differ from 94002 or 94003?
94004 is for daily management of noninvasive ventilation in acute respiratory failure. Codes 94002 and 94003 describe inpatient or observation management of pressure- or volume-preset ventilators, with 94002 for the initial day and 94003 for a subsequent day.
Is 94004 reported per day or per ventilator adjustment?
It is a per-day service, not a separate unit for each hour, setting change, or mask adjustment.
What documentation supports reporting 94004?
Document the acute respiratory failure, the noninvasive support being managed, and the physician's assessment and management of the patient's respiratory status for that day.
Is 94004 the code for routine home ventilator supervision?
No. Code 94005 is associated with home ventilator management; 94004 describes daily management of noninvasive ventilation for acute respiratory failure.
How is 94004 distinguished from 94660?
Use 94004 for daily management of noninvasive ventilation in acute respiratory failure. Code 94660 describes CPAP ventilation initiation and management in its own clinical context.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
12,35993998,,Unlistd noninvas vasc dx std,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,XXX,0.00,0.00,0.00,0,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
12,36094002,,Vent mgmt inpat init day,A,,1.99,0.40,NA,0.40,,0.18,2.57,2.57,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,36194003,,Vent mgmt inpat subq day,A,,1.37,0.28,NA,0.28,,0.12,1.77,1.77,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,36294004,,Vent mgmt nf per day,A,,1.00,0.24,NA,0.24,,0.07,1.31,1.31,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,36394005,,Home vent mgmt supervision,B,+,1.50,1.22,,1.22,NA,0.08,2.80,2.80,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
12,36494010,,Breathing capacity test,A,,0.17,0.70,,0.70,NA,0.02,0.89,0.89,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,36594010,26,Breathing capacity test,A,,0.17,0.07,,0.07,,0.01,0.25,0.25,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503