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    OpenPayerBilling CodesPulmonary Diagnostic Testing and TherapiesCPT cpt-94375-respiratory-flow-volume-loop-study
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    CPT 94375: Respiratory Flow-Volume Loop Study

    Medicare pays $29 and commercial payers pay $97 on average nationally for this procedure.

    CPT code 94375 describes a respiratory flow-volume loop study performed to differentiate obstructive versus restrictive pulmonary disorders, characterize disease severity, and assess response to therapy; service type: diagnostic pulmonary function testing; typical site of service: hospital outpatient clinic, pulmonary function laboratory, or office-based pulmonary clinic.

    For related coverage guidance, see recent payer policy updates: Nitric Oxide Therapy - Inhaled, Pulmonary Rehabilitation, Home Non-Invasive Positive Pressure Ventilation (NIPPV) Devices for Respiratory Insufficiency and Failure.

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    National Reimbursement Benchmarks

    Medicare’s mean rate of $29.2 sits well below BUCA’s average commercial mean of $96.5, reflecting a substantial gap between federal reimbursement and this commercial benchmark. The median Medicare locality value is $28, close to Medicare’s mean, while BUCA’s median of $95 suggests its distribution is centered much higher; this highlights materially higher commercial reimbursements relative to Medicare for CPT 94375. Dispersion measured as P75 minus P25 shows Blue Cross Blue Shield with a tight spread of $34.6 ($150.9 - $116.3) and Aetna with a narrower spread of $21.4 ($41.1 - $19.7). The widest dispersion appears with BCBS (Blue Cross Blue Shield) is actually the widest in absolute rates due to higher levels, while Cigna’s spread is $31.9 ($55.3 - $23.4) and UnitedHealth Group’s spread is $25.4 ($51.3 - $23.6); BUCA’s interquartile spread is $29.7 ($107.3 - $76.0) and Medicare’s interquartile range is $25.5 ($40.5 - $15.0). These differences point to varying price concentration across payers, with Blue Cross Blue Shield and Cigna showing relatively broader dispersion around their medians.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 62-year-old patient with a long smoking history presents to a pulmonary clinic with progressive exertional dyspnea and intermittent wheezing. The clinician documents suspected chronic obstructive pulmonary disease and possible mixed obstructive-restrictive physiology after auscultation and chest imaging that do not fully explain symptoms. The patient is scheduled for a respiratory flow volume loop study (94375) to differentiate obstructive from restrictive patterns, quantify severity, and assess baseline lung mechanics prior to initiation or adjustment of inhaled bronchodilator therapy.

    The clinical workflow: the patient checks in at an outpatient pulmonary function laboratory in the ambulatory clinic. A respiratory therapist confirms indications and contraindications, reviews recent bronchodilator use, and obtains informed consent. Baseline spirometry and then flow-volume loop measurements are performed per standardized technique with coaching; repeat measures post-bronchodilator may be obtained if clinically indicated. The interpreting pulmonary physician documents the loop tracings, interprets obstructive versus restrictive pattern, stages severity, and documents impact on management. Results are entered into the electronic medical record and communicated to the referring provider for therapy decisions or further testing (e.g., full pulmonary function testing or imaging). Typical sites of service include outpatient pulmonary function labs, ambulatory clinics, and hospital-based pulmonary labs; the service type is diagnostic physiologic testing of pulmonary function.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    95Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207RP1001X
    207RC0200X
    207RI0008X
    156FC0801X
    2083A0100X
    261QC1800X
    261QL0400X
    372500000X

    Related ICD-10-CM Codes

    24 rows

    ICD-10-CM CodeDescription
    E66.9Obesity, unspecified
    G47.33Obstructive sleep apnea (adult) (pediatric)
    I10Essential (primary) hypertension
    J43.9Emphysema, unspecified
    J44.0Chronic obstructive pulmonary disease with (acute) lower respiratory infection
    J44.1Chronic obstructive pulmonary disease with (acute) exacerbation
    J44.9Chronic obstructive pulmonary disease, unspecified
    J45.22Mild intermittent asthma with status asthmaticus
    J45.30Mild persistent asthma, uncomplicated
    J45.901Unspecified asthma with (acute) exacerbation

    Showing 1–10 of 24

    Related Payer Policy Updates

    Specialty: Pulmonology1 / 2

    10 rows

    PolicyPayerEffective Date
    Nitric Oxide Therapy - InhaledModa Health2026-11-01
    Pulmonary RehabilitationModa Health2026-11-01
    Home Non-Invasive Positive Pressure Ventilation (NIPPV) Devices for Respiratory Insufficiency and Failureuniverahealthcare2026-10-15
    Bronchial Thermoplasty (for North Carolina Only)UnitedHealthcare2026-10-01
    Bronchial Thermoplasty (for New Mexico Only) UnitedHealthcare Community Plan Medical PolicyUnitedHealthcare2026-10-01
    Bronchial Thermoplasty (for Kentucky Only)UnitedHealthcare2026-10-01
    Bronchial Thermoplasty (for Kansas Only)UnitedHealthcare2026-10-01
    Inhaled Nitric Oxide TherapyUnitedHealthcare2026-10-01
    Bronchial Thermoplasty for AsthmaUnitedHealthcare2026-10-01
    Bronchial Thermoplasty (for New Jersey Only)UnitedHealthcare2026-10-01

    Related Codes

    CPT-94010-DIAGNOSTIC-SPIROMETRY-VITAL-CAPACITY-EXPIRATORY-FLOW

    CPT 94010: Spirometry with Vital Capacity and Expiratory Flow

    CPT-94011-PEDIATRIC-FORCED-EXPIRATORY-FLOW-TEST-INFANTS

    CPT 94011: Infant/Child Forced Expiratory Flow Pulmonary Test

    CPT-94012-PEDIATRIC-FORCED-EXPIRATORY-FLOW-BRONCHODILATION

    CPT 94012: Infant/Child Forced Expiratory Flow with Bronchodilation

    CPT-94013-INFANT-CHILD-PULMONARY-FUNCTION-TEST

    CPT 94013: Pulmonary Function Test for Infant/Child Up to Age 2

    CPT-94014-REMOTE-SPIROMETRY-30-DAY-HOME-MONITORING

    CPT 94014: Home Serial Spirometry Monitoring, 30-Day

    CPT-94015-HOME-SPIROMETRY-30-DAY-TECHNICAL-COMPONENT

    CPT 94015: 30-Day Remote Spirometry, Technical Component

    CPT-94016-HOME-SPIROMETRY-PROFESSIONAL-INTERPRETATION-30-DAY

    CPT 94016: Ambulatory Daily Spirometry, Professional Interpretation

    CPT-94060-SPIROMETRY-BRONCHODILATOR-RESPONSIVENESS-TEST

    CPT 94060: Spirometry with Bronchodilator Response Testing

    CPT-94070-BRONCHIAL-PROVOCATION-TEST-SPIROMETRY

    CPT 94070: Bronchoprovocation with Spirometry

    CPT-94150-TOTAL-VITAL-CAPACITY-MEASUREMENT

    CPT 94150: Total Vital Capacity Measurement

    Showing 1–10 of 48

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    94200
    Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s) (e.g., multiple flow–volume loops)
    Overlaps with flow-volume measurement; may be billed when full spirometry including timed vital capacity is performed in addition to or instead of 94375.

    Note: Only related CPT codes provided in the input are listed above.