CPT 94010: Spirometry with Vital Capacity and Expiratory Flow
Medicare pays $21 and commercial payers pay $93 on average nationally for this procedure.
CPT code 94010 describes a spirometry test in which a provider or technician uses a spirometer attached to a computer to record total and timed vital capacity and expiratory flow rates and to display results as a graph; the service is a pulmonary function diagnostic test typically performed in an outpatient clinic, pulmonary function laboratory, or hospital-based pulmonary testing area and may require a sustained forced exhalation over 12–15 seconds after deep inspiration.
For related coverage guidance, see recent payer policy updates: Home Non-Invasive Positive Pressure Ventilation (NIPPV) Devices for Respiratory Insufficiency and Failure, Bronchial Valves, Pulmonary Arterial Hypertension Endothelin Receptor Antagonists.
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National Reimbursement Benchmarks
Medicare’s mean rate sits at $20.6, notably lower than BUCA’s commercial average of $93.2, highlighting a substantial gap between federal reimbursement and this commercial benchmark. BUCA’s median ($90.8) and mean proximity suggest its commercial contracting is centered higher than Medicare, while Aetna, Cigna, and UnitedHealth Group mean rates fall between those endpoints, reinforcing the spread from public to commercial payers.
Dispersion measured as P75 minus P25 is widest for Blue Cross Blue Shield at $39.6 ($156.8 − $117.2) and narrowest for Aetna at $24.2 ($40.0 − $15.8). UnitedHealth Group and Cigna show similar dispersion of $28.3 ($48.0 − $18.7) and $29.9 ($44.9 − $15.9) respectively, while BUCA’s interquartile spread is $16.4 ($108.6 − $74.2). This highlights varying price consistency across payers, with Blue Cross Blue Shield exhibiting the largest spread and BUCA the tightest IQR among listed commercial payers.