Summary & Overview
CPT 94060: Bronchodilation Responsiveness Testing with Spirometry
CPT code 94060 is a critical procedure in pulmonary medicine, used to assess bronchodilation responsiveness through spirometry before and after bronchodilator administration. This test is widely utilized in outpatient settings to evaluate lung function in patients with asthma, chronic obstructive pulmonary disease (COPD), and other respiratory conditions. The code is recognized by major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare, ensuring broad coverage for patients across the United States.
This publication provides a comprehensive overview of CPT code 94060, including its clinical significance, payer coverage, and associated billing practices. Readers will gain insight into relevant modifiers such as 26 (Professional Component) and TC (Technical Component), as well as the typical clinical scenarios and diagnoses linked to this procedure. The article also highlights related CPT codes for pulmonary function testing, offering context for how 94060 fits within broader respiratory diagnostic workflows. Key policy updates and benchmarks are discussed to inform stakeholders about current trends and requirements in medical billing and reimbursement for pulmonary diagnostic services.
Healthcare professionals, billing specialists, and policy analysts will find this summary useful for understanding the national landscape of coverage, coding, and clinical application for bronchodilation responsiveness testing.
CPT Code Overview
CPT code 94060 represents the assessment of bronchodilation responsiveness using spirometry, performed both before and after the administration of a bronchodilator. This procedure is a key component of pulmonary diagnostic testing and therapies, providing valuable information about airway function and response to treatment. The typical site of service for this test is an office setting, such as an outpatient pulmonary function laboratory. The test is commonly used to evaluate patients with respiratory symptoms or conditions, helping clinicians determine the effectiveness of bronchodilator therapy and guide further management.
Clinical & Coding Specifications
Clinical Context
A patient presents to the outpatient pulmonary function lab with symptoms such as shortness of breath, wheezing, or cough. The clinician suspects a condition like asthma or chronic obstructive pulmonary disease (COPD). To assess airway responsiveness, spirometry is performed before and after administration of a bronchodilator. The results help determine the degree of reversible airway obstruction and guide further management. This workflow is typical for patients with suspected or known obstructive lung diseases.
Coding Specifications
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Modifiers:
26: Professional Component – Used when only the physician's interpretation and report are billed, not the technical performance.TC: Technical Component – Used when only the technical performance of the test is billed, not the physician's interpretation.
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207RP1000X | Pulmonary Disease (Pulmonology) |
221H00000X | Respiratory Therapy |
- Specialties Represented:
- Pulmonologists
- Respiratory Therapists
Related Diagnoses
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J45.909: Unspecified asthma, uncomplicated- Relevant for patients with suspected or known asthma; spirometry with bronchodilator helps assess reversibility.
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J44.9: Chronic obstructive pulmonary disease, unspecified- Used for patients with COPD; bronchodilator responsiveness testing helps differentiate between asthma and COPD.
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R06.02: Shortness of breath- Common presenting symptom; spirometry assists in identifying underlying pulmonary causes.
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J98.01: Acute bronchospasm- Indicates acute airway narrowing; bronchodilator testing evaluates response to therapy.
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R06.89: Other abnormalities of breathing- Used for patients with non-specific breathing abnormalities; spirometry helps clarify the diagnosis.
Related CPT Codes
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94010: Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation- Used as the baseline spirometry test; forms the basis for pre- and post-bronchodilator testing in
94060.
- Used as the baseline spirometry test; forms the basis for pre- and post-bronchodilator testing in
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94726: Pulmonary function testing by plethysmography (lung volumes)- Assesses lung volumes; may be performed alongside spirometry for comprehensive pulmonary function evaluation.
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94729: Diffusion capacity of the lung for carbon monoxide (DLCO)- Measures gas exchange efficiency; often used with spirometry in evaluating lung diseases.
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94070: Bronchospasm provocation evaluation, multiple spirometric determinations as in94010, with administered agents- Used to assess airway hyperreactivity; an alternative or adjunct to bronchodilator responsiveness testing.
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Commonly Used Together:
94010and94060are often performed sequentially in the same patient visit.94726and94729may be ordered for a more complete assessment of pulmonary function.94070is used when bronchospasm provocation is clinically indicated instead of bronchodilator responsiveness.
National Reimbursement Benchmarks
Medicare's national mean rate for CPT code 94060 is $30.18, which is significantly lower than the BUCA (average commercial) mean rate of $46.63. Commercial payers such as UnitedHealth Group and Cigna report even higher mean rates, at $60.31 and $54.02 respectively, highlighting a substantial gap between public and private reimbursement levels.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies notably across payers. Medicare exhibits the widest spread ($31.00), indicating greater variability in rates, while Aetna shows the tightest range ($18.25), suggesting more consistent reimbursement. Cigna and UnitedHealth Group also display broad ranges, at $25.33 and $28.67 respectively.
The table and chart below present the full breakdown of national benchmarks for CPT code 94060 across major payers.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska exhibits a substantial rate spread for CPT code 94060 across payers, with UnitedHealth Group showing the highest 75th percentile rate at $96.67 and Medicare the lowest at $11.00. The commercial payers (Aetna, Blue Cross Blue Shield, Cigna, UnitedHealth Group, and BUCA) all have 75th percentile rates well above $54, while Medicare's rates are notably lower. The difference between the 75th and 25th percentiles is most pronounced for Blue Cross Blue Shield ($28.35) and UnitedHealth Group ($16.67), indicating significant variability in reimbursement depending on payer.
Compared to national averages, Alaska's mean rates for commercial payers are considerably higher, with UnitedHealth Group and Blue Cross Blue Shield leading the deviation. Medicare's mean rate in Alaska is slightly below the national average, but the commercial payers far exceed their national benchmarks. The table and chart below present the full breakdown of payer-specific rates for Alaska.
Key Insights for Alaska
- UnitedHealth Group is the highest paying payer for CPT 94060 in Alaska, with a mean rate of $92.89.
- Medicare is the lowest paying payer, with a mean rate of $28.98, significantly below the commercial payers.
- All commercial payers in Alaska reimburse at rates well above their respective national averages, with UnitedHealth Group and Blue Cross Blue Shield showing the largest deviations.
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