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CPT 94010: Diagnostic Spirometry, Vital Capacity and Expiratory Flow
CPT code 94010 represents a standard diagnostic spirometry test used to quantify lung function by measuring vital capacity and expiratory flow rates. Nationally, spirometry is a common objective tool for diagnosing and monitoring obstructive and restrictive respiratory conditions, guiding management decisions and helping document functional impairment. Key payers in the national landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
This publication explains the clinical purpose and scope of CPT code 94010, typical sites of service, and its role within pulmonary diagnostic workflows. Readers will find concise information on the clinical context for ordering spirometry, comparable and related procedures, and the primary payer groups relevant to coverage and billing. The content highlights how CPT code 94010 fits alongside related services such as pre- and post-bronchodilator spirometry and advanced lung volume measurements, providing a clear reference for coding and clinical documentation needs.
Intended for national audiences of clinicians, coders, and administrators, the summary clarifies what the procedure measures, where it is commonly performed, and which major payers are relevant for coverage considerations. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 94010 describes a spirometry test performed by a provider or technician to assess a patient's respiratory function. The procedure records total and timed vital capacity (maximum expired air) and expiratory flow rate, with results displayed as a graph. The test may require the patient to exhale rapidly for approximately 12 to 15 seconds after a deep inhalation.
Service type: Pulmonary function testing — diagnostic spirometry
Typical site of service: Outpatient clinic, pulmonary function laboratory, or physician office
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.