Summary & Overview
CPT 94013: Infant and Child Pulmonary Function Test up to Age Two
CPT code 94013 represents a specialized pulmonary function test performed for infants and children up to two years old to measure lung volumes and capacities across the respiratory cycle. This diagnostic service is clinically important for early identification and characterization of pediatric respiratory conditions such as congenital or early-onset obstructive and restrictive lung disease, recurrent wheeze, and failure to thrive related to pulmonary dysfunction. Nationally, appropriate coding and interpretation of infant pulmonary function testing supports accurate clinical management and alignment with payer coverage policies.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical and billing context for CPT code 94013, typical sites of service, common modifiers and billing considerations, and which payers commonly reimburse or require prior authorization for infant pulmonary function testing. The publication summarizes benchmark topics such as expected service lines, payer policy themes, and clinical indications for testing, and it highlights where input data was not available. Data not available in the input will be explicitly noted where applicable.
Billing Code Overview
CPT code 94013 describes a pulmonary function test for an infant or child up to two years of age that measures lung volumes and capacities at different points during breathing using specialized infant/child techniques. The procedure evaluates the amount of air in the lungs and helps determine a range of lung conditions in very young patients.
Service Type: Pulmonary function testing (infant/early childhood)
Typical Site of Service: Hospital outpatient pulmonary lab, pediatric pulmonary clinic, or specialized diagnostic laboratory
Clinical & Coding Specifications
Clinical Context
A 10-month-old infant with a history of recurrent wheeze and suspected reactive airways disease is referred by a pediatric pulmonologist for infant pulmonary function testing. The child arrives to the pediatric pulmonary lab accompanied by a parent. After verifying identity and consent, a respiratory therapist explains the procedure, ensures the infant is calm or lightly sedated per clinic protocol, and applies appropriate facemask or infant body plethysmography fittings. The test sequence is tailored for age: tidal breathing measurements, raised volume rapid thoracoabdominal compression (RVRTC) or infant plethysmography to determine lung volumes and flows, and bronchodilator responsiveness if clinically indicated. The provider documents indications, pretest vitals, technique used, any sedation or ancillary services, and interprets results in the medical record. Typical workflow includes scheduling, pre-procedure assessment, technician-performed maneuvers under physician supervision, data acquisition and quality checks, formal interpretation by the physician, and billing using 94013 for the infant/child up to two years for specialized pulmonary function testing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing for the physician interpretation only and the facility bills separately for technical services. |