Billing code 94200: Lung function testMedicare rate & RVUs in Delaware
Reports a maximum voluntary ventilation maneuver during pulmonary function testing to assess ventilatory capacity, typically as part of a broader respiratory evaluation.
Medicare pays $16.14 for 94200 in the office in Delaware (Delaware). 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.
On this page 9 sections
What 94200 covers
This pulmonary function test measures the amount of air a patient can move with rapid, sustained breathing over a brief testing period. The result is used to assess ventilatory capacity and may help characterize respiratory impairment. A respiratory therapist or pulmonary function technician typically performs the maneuver in a pulmonary function laboratory or clinic, with a physician interpreting the results.
Select this code when the documented service is a maximum voluntary ventilation measurement, rather than spirometry, lung-volume measurement, or another pulmonary function test. The record should identify the test performed and include its results and interpretation. CMS recognizes professional and technical components: report modifier 26 for interpretation, modifier TC for equipment and staff, or neither modifier when billing the global service, which includes both components.
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.
94200 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | $16.14 | Unavailable |
How the 94200 rate is calculated
Each of 94200’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 · 94200
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.05Practice expense 0.42Malpractice 0.02
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 94200
The CMS indicators that decide how 94200 is paid alongside other services.
CMS payment indicators · 94200
Lung function test
| 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 | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
94200 without 26 · national office
$16.37
Lung function test
94200-26 · Professional component
$2.67
Pays only the interpretation and report.
94200 compared with similar codes
Compare codes
94200 vs 94010 vs 94150 vs 94726: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 94010Spirometry
- Use 94010 for spirometry measurements of airflow and lung volume during forced breathing maneuvers. Use 94200 when the service measures maximum voluntary ventilation through sustained rapid breathing.
- 94150Vital capacity test
- 94150 measures vital capacity, the volume exhaled after a maximal inhalation. Code 94200 represents a separate maximum voluntary ventilation measurement.
- 94726Body plethysmography
- 94726 measures lung volumes, commonly using body plethysmography. Code 94200 measures ventilatory capacity during rapid, sustained breathing.
94200 billing questions
How does this test differ from spirometry?
Maximum voluntary ventilation measures sustained ventilatory capacity during rapid, repeated breathing. Spirometry measures specific airflow and volume values during defined breathing maneuvers.
Can modifier 26 or TC be reported?
Yes. Modifier 26 identifies the professional interpretation, and modifier TC identifies the technical service, including equipment and staff. Without either modifier, the claim represents the global service.
What documentation supports reporting this code?
Document that maximum voluntary ventilation was performed, the resulting measurement, and the physician's interpretation. The record should distinguish this test from other pulmonary function measurements performed during the encounter.
Can this be reported with other pulmonary function tests?
It may be reported with other tests when those distinct measurements are performed and documented. For example, spirometry or lung-volume testing may be part of the same broader pulmonary function evaluation.
Is this code reported for each breathing maneuver?
The code identifies the maximum voluntary ventilation test, not each individual breath or maneuver. Report the service based on the completed test and its documentation.
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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