CPT 94610 Endotracheal Surfactant Reimbursement | OpenPayer

Summary & Overview

CPT 94610: Endotracheal Surfactant Administration

CPT code 94610 covers endotracheal administration of surfactant by a qualified provider, a therapeutic pulmonary procedure used to treat respiratory conditions such as cystic fibrosis. This procedure is an important intervention in acute care, typically performed in hospital inpatient settings or intensive care units where secure airway management is available. Nationally, surfactant administration carries clinical significance for patients with severe respiratory dysfunction and can affect length of stay, ventilator dependence, and resource use.

Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a national-level view rather than state-specific guidance.

Readers will find a concise explanation of the clinical context and service setting for CPT code 94610, an outline of typical payer considerations, and sections covering common modifiers and coding context where available. The report also highlights benchmarking concepts, coding practice notes, and policy or coverage considerations relevant to hospitals and post-acute providers. Data not available in the input is identified where necessary.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare94610CPTsurfactant administrationpulmonary procedureendotracheal intubationhospital inpatientICUrespiratory therapyprocedural coding

Billing Code Overview

CPT code 94610 describes administration of a surfactant directly into the lungs through an endotracheal tube. The procedure is performed by a provider or other qualified health care professional to treat respiratory conditions such as cystic fibrosis where surfactant replacement is clinically indicated.

Service type: Therapeutic pulmonary procedure — endotracheal surfactant administration

Typical site of service: Hospital inpatient or neonatal/pediatric intensive care unit (ICU) or other acute care setting where endotracheal intubation and airway management are performed.

Clinical & Coding Specifications

Clinical Context

A neonate or infant with respiratory distress and surfactant deficiency is intubated in the neonatal intensive care unit (NICU) or pediatric intensive care unit (PICU) for mechanical ventilation. The clinician prepares and instills exogenous surfactant via the endotracheal tube to improve lung compliance and oxygenation. Typical workflow: assessment of respiratory status and indication (e.g., increasing oxygen requirements, persistent hypoxemia, or radiographic findings consistent with surfactant deficiency), confirmation of airway placement, dosing and preparation of the surfactant medication, brief manual ventilation or ventilator adjustments during instillation, post‑administration suctioning as indicated, and close monitoring of vital signs and blood gases. The procedure is commonly performed by neonatologists, pediatric intensivists, respiratory therapists under direction, or other qualified providers in an ICU setting; it may be billed when the provider performs endotracheal instillation of surfactant for treatment of conditions such as neonatal respiratory distress syndrome or other surfactant-deficient states.

Coding Specifications

Modifier	Description	When to Use
`00`	Description not otherwise specified for local use	Data not available in the input.
`11`

CPT 94729: Lung Diffusing Capacity (DLCO) Measurement

CPT-94625-OUTPATIENT-PULMONARY-REHABILITATION-SESSION

CPT 94625: Outpatient Pulmonary Rehabilitation Session

CPT-94660-CPAP-INITIATION-AND-PATIENT-TRAINING

CPT 94660: Initiation of CPAP Ventilation and Patient Training

CPT-94760-SPOT-CHECK-OXYGEN-SATURATION-FINGER-EAR

CPT 94760: Single Measurement of Oxygen Saturation (Finger or Ear)

CPT-94772-INFANT-CARDIORESPIRATORY-MONITORING-SLEEP

CPT 94772: Infant Cardiorespiratory Monitoring During Sleep

CPT-94626-PULMONARY-REHABILITATION-SESSION-OXIMETRY-MONITORING

CPT 94626: Outpatient Pulmonary Rehabilitation Session with Oximetry

CPT-94013-INFANT-CHILD-PULMONARY-FUNCTION-TEST

CPT 94013: Infant and Child Pulmonary Function Test up to Age Two

CPT-94015-HOME-SPIROMETRY-30-DAY-TECHNICAL-COMPONENT

CPT 94015: 30-Day Home Spirometry, Technical Component

CPT-94669-MECHANICAL-CHEST-COMPRESSION-AIRWAY-CLEARANCE

CPT 94669: Mechanical Chest Compression for Airway Clearance

CPT-94667-CHEST-PHYSICAL-THERAPY-MANUAL-AIRWAY-CLEARANCE

CPT 94667: Chest Physical Therapy to Mobilize Lung Secretions

Showing 1–10 of 48

Taxonomy Code	Specialty	Notes
208000000X	Neonatology	Primary specialty performing surfactant administration in neonates.
208000000N	Pediatric Critical Care Medicine	Performs surfactant administration in critically ill infants in the PICU.
207Q00000X	Pulmonology	Pediatric pulmonologists may be involved in respiratory management and surfactant therapy.
363L00000X	Respiratory Therapy	Respiratory therapists commonly assist with preparation, instillation, and ventilator management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`P22.0`	Neonatal respiratory distress syndrome	Primary indication for surfactant administration in preterm neonates with surfactant deficiency.
`P28.5`	Respiratory failure of newborn	Surfactant may be administered to newborns with respiratory failure secondary to surfactant deficiency.
`E84.0`	Cystic fibrosis with pulmonary manifestations	Chronic pulmonary conditions like cystic fibrosis can involve surfactant therapies in specific contexts.
`J96.90`	Respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia	Respiratory failure may prompt surfactant therapy when surfactant dysfunction is suspected.
`J80`	Acute respiratory distress syndrome	In select cases of ARDS with surfactant dysfunction, exogenous surfactant may be considered.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`31500`	Intubation, endotracheal, emergency procedure	Often performed immediately before `94610` when establishing an airway for surfactant instillation.
`94002`	Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation	Represents initiation of mechanical ventilation care related to the need for surfactant therapy.
`31600`	Tracheostomy, emergency placement of endotracheal tube not applicable — (Note: included for airway procedures)	May be related when alternative airway management is required; selection depends on clinical situation.
`94640`	Inhalation treatment for acute airway obstruction, aerosolized medications by nebulizer	May be performed adjunctively for bronchospasm management in patients receiving surfactant.
`94060`	Capillary blood, puncture, collection for blood gas, single determination	Laboratory assessment commonly performed before and after surfactant instillation to evaluate gas exchange.

OpenPayer