Billing code 94011: Infant spirometryMedicare rate & RVUs in Washington
Reports specialized spirometry for a child age 2 years or younger, measuring vital capacity and expiratory flow with infant-appropriate testing methods.
CMS doesn’t publish an office rate for 94011 in Washington.
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 94011 covers
94011 represents pulmonary function testing adapted for infants who cannot reliably perform routine spirometry maneuvers. The test produces a graphic record and measurements of vital capacity and expiratory flow using techniques and equipment suited to a child age 2 or younger. It is typically performed by a pulmonary function laboratory or pediatric pulmonary service in an outpatient clinic or hospital when evaluating respiratory symptoms such as wheezing or suspected obstructive disease.
Choose this code based on the patient’s age and the infant spirometry performed, not simply because a young child had a breathing assessment. Document the indication, the child’s age, the testing method, and the resulting curves or measurements. Report additional infant lung-volume or enhanced spirometry services only when those distinct procedures are performed and documented. CMS values the service through physician-work, practice-expense, and malpractice inputs; use the applicable fee schedule rate for the claim’s payment context.
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 94011 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $72.46 |
| Seattle (King Cnty) | Unavailable | $76.77 |
How the 94011 rate is calculated
Each of 94011’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 · 94011
RVUs × geographic indexes × conversion factor
Work1.71
1.71 RVUs× 1.000 GPCI
Practice expense0.35
0.35 RVUs× 1.000 GPCI
Malpractice0.09
0.09 RVUs× 1.000 GPCI
Adjusted RVUs
2.1500
Conversion factor
$33.4009
Medicare rate
$71.81
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 94011
94011 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 94011
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
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94011 isn’t priced in this setting.
94011 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 94010Spirometry
- Choose 94011 for infant-specific spirometry in a child age 2 or younger. Use 94010 for general spirometry when the patient can perform standard maneuvers.
- 94012Infant spirometry
- Both codes concern infant spirometry, but 94012 includes additional flow-volume loop or bronchodilator-responsiveness testing.
- 94013Lung-volume test
- 94011 measures infant spirometry, including vital capacity and expiratory flow; 94013 is for distinct infant lung-volume measurements.
94011 billing questions
How is 94011 different from 94010?
94011 is for infant spirometry in a child age 2 or younger, using testing suited to the infant. 94010 is the general spirometry code for patients who can perform standard spirometry maneuvers.
When should 94012 be used instead?
Use 94012 when the infant spirometry service includes the additional flow-volume loop or bronchodilator-responsiveness testing represented by that code. Do not select it solely because the patient is an infant.
Are the graphic record and flow measurements separate services?
The graphic record and vital-capacity and expiratory-flow measurements are elements of 94011. They are not separately reported as individual services when they are part of the same infant spirometry test.
What documentation supports reporting 94011?
Document the child’s age, the clinical reason for testing, the infant-appropriate spirometry performed, and the resulting measurements or tracing. The record should distinguish any separately performed lung-volume or enhanced spirometry testing.
Is 94011 reported once per maneuver?
No. Report the infant spirometry service, not each individual maneuver or tracing.
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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