CPT 94375: Respiratory Flow-Volume Loop Study
CPT code 94375 describes a respiratory flow volume loop study used to distinguish obstructive from restrictive pulmonary disorders, quantify disease severity, and evaluate treatment response. Nationally, this diagnostic pulmonary function test supports clinical decision-making for patients with dyspnea, wheeze, suspected asthma, COPD, and other lung disorders and has implications for care pathways and utilization of pulmonary specialty services. Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical purpose and typical settings for 94375, a comparison to related spirometry services, and an overview of payer coverage considerations and coding relationships that affect billing and documentation. The publication also highlights common clinical indications and expected sites of service for the procedure. Data not available in the input for payer-specific rates and utilization benchmarks are not included.
Customize your policy alerts
Sign up for cpt 94375 policy alerts
Get alerted when payer policies referencing 94375 are released or updated.
Monitor payer policy activity
Billing Code Overview
CPT code 94375 represents a respiratory flow volume loop study used to differentiate obstructive pulmonary disorders from restrictive pulmonary disorders. The procedure is also used to characterize disease severity and measure response to therapy. Providers obtain flow–volume loop data to assess pulmonary mechanics and guide diagnostic interpretation.
Service type: Pulmonary diagnostic testing / pulmonary function testing
Typical site of service: Hospital outpatient departments, pulmonary function laboratories, and physician offices with pulmonary testing capability
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.