94011 Spirometry up to 2 yrs old
What 94011 is
CMS fee schedule short descriptor: Spirometry up to 2 yrs old.
Full CPT long descriptions are licensed by the American Medical Association and are not published on this site; the short descriptor above is the one CMS prints in its own fee schedule file. See About CPT.
Medicare payment for 94011 (CY2026)
| Work RVU | Practice expense RVU | Malpractice RVU | Total | Medicare rate | |
|---|---|---|---|---|---|
| Non-facility (office) | 1.71 | 0.35 | 0.09 | 2.15 | $71.81 |
| Facility (hospital, ASC) | 1.71 | 0.35 | 0.09 | 2.15 | $71.81 |
National rates: total RVUs x the CY2026 conversion factor of 33.4009 (non-QP), before geographic adjustment. Actual Medicare payment is 80% of the rate shown after the deductible; the patient or secondary payer owes the 20% coinsurance.
Status: Active - payable under the Physician Fee Schedule. Global period: Global concept does not apply.
Medically Unlikely Edit (MUE)
Medicare caps 94011 at 1 unit per date of service for practitioner claims (MAI 3 - date of service edit (clinical): units above the MUE may pay with documentation on appeal), rationale: Nature of Service/Procedure. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.
Billed with 94011? These codes are bundled into it
94011 is a Column 1 code in 41 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.
| Column 2 code | Short description | Modifier indicator | |
|---|---|---|---|
36591 | Draw blood off venous device | 0 - no modifier bypass | Check pair |
36592 | Collect blood from picc | 0 - no modifier bypass | Check pair |
94010 | Breathing capacity test | 1 - modifier may bypass | Check pair |
94200 | Lung function test (mbc/mvv) | 1 - modifier may bypass | Check pair |
94375 | Respiratory flow volume loop | 1 - modifier may bypass | Check pair |
94728 | Airwy resist by oscillometry | 1 - modifier may bypass | Check pair |
96523 | Irrig drug delivery device | 0 - no modifier bypass | Check pair |
99202 | Office o/p new sf 15 min | 1 - modifier may bypass | Check pair |
99203 | Office o/p new low 30 min | 1 - modifier may bypass | Check pair |
99204 | Office o/p new mod 45 min | 1 - modifier may bypass | Check pair |
99205 | Office o/p new hi 60 min | 1 - modifier may bypass | Check pair |
99211 | Off/op est may x req phy/qhp | 1 - modifier may bypass | Check pair |
99212 | Office o/p est sf 10 min | 1 - modifier may bypass | Check pair |
99213 | Office o/p est low 20 min | 1 - modifier may bypass | Check pair |
99214 | Office o/p est mod 30 min | 1 - modifier may bypass | Check pair |
99215 | Office o/p est hi 40 min | 1 - modifier may bypass | Check pair |
99281 | Emr dpt vst mayx req phy/qhp | 1 - modifier may bypass | Check pair |
99282 | Emergency dept visit sf mdm | 1 - modifier may bypass | Check pair |
99283 | Emergency dept visit low mdm | 1 - modifier may bypass | Check pair |
99284 | Emergency dept visit mod mdm | 1 - modifier may bypass | Check pair |
99285 | Emergency dept visit hi mdm | 1 - modifier may bypass | Check pair |
99304 | 1st nf care sf/low mdm 25 | 1 - modifier may bypass | Check pair |
99305 | 1st nf care moderate mdm 35 | 1 - modifier may bypass | Check pair |
99306 | 1st nf care high mdm 50 | 1 - modifier may bypass | Check pair |
99307 | Sbsq nf care sf mdm 10 | 1 - modifier may bypass | Check pair |
99308 | Sbsq nf care low mdm 20 | 1 - modifier may bypass | Check pair |
99309 | Sbsq nf care moderate mdm 30 | 1 - modifier may bypass | Check pair |
99310 | Sbsq nf care high mdm 45 | 1 - modifier may bypass | Check pair |
99315 | Nf dschrg mgmt 30 min/less | 1 - modifier may bypass | Check pair |
99316 | Nf dschrg mgmt 30 min+ | 1 - modifier may bypass | Check pair |
Showing 30 of 41 column 2 codes. Use the pair checker for any specific combination.
94011 is bundled into these codes
94011 appears as a Column 2 code in 8 active edits. Reported with one of these Column 1 codes on the same date of service, 94011 is the code that denies.
| Column 1 code | Short description | Modifier indicator | |
|---|---|---|---|
94012 | Spirmtry w/brnchdil inf-2 yr | 0 | Check pair |
94014 | Patient recorded spirometry | 1 | Check pair |
94015 | Patient recorded spirometry | 1 | Check pair |
94060 | Evaluation of wheezing | 1 | Check pair |
94070 | Evaluation of wheezing | 1 | Check pair |
94617 | Exercise tst brncspsm w/ecg | 1 | Check pair |
94618 | Pulmonary stress testing | 1 | Check pair |
94621 | Cardiopulm exercise testing | 1 | Check pair |
Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.