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: 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 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.