94642 Aerosol inhalation treatment
What 94642 is
CMS fee schedule short descriptor: Aerosol inhalation treatment.
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 94642 (CY2026)
This code has no Physician Fee Schedule rate: Carrier-priced - the Medicare contractor sets the price. It may be paid under a different fee schedule (clinical laboratory, DMEPOS, anesthesia) or not paid at all - check the relevant CMS schedule.
Medically Unlikely Edit (MUE)
Medicare caps 94642 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 94642? These codes are bundled into it
94642 is a Column 1 code in 38 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 | |
|---|---|---|---|
00520 | Anes closed chest px nos | 0 - no modifier bypass | Check pair |
36591 | Draw blood off venous device | 0 - no modifier bypass | Check pair |
36592 | Collect blood from picc | 0 - no modifier 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 |
99341 | Home/res vst new sf mdm 15 | 1 - modifier may bypass | Check pair |
99342 | Home/res vst new low mdm 30 | 1 - modifier may bypass | Check pair |
99344 | Home/res vst new mod mdm 60 | 1 - modifier may bypass | Check pair |
Showing 30 of 38 column 2 codes. Use the pair checker for any specific combination.
94642 is bundled into these codes
94642 appears as a Column 2 code in 1 active edits. Reported with one of these Column 1 codes on the same date of service, 94642 is the code that denies.
| Column 1 code | Short description | Modifier indicator | |
|---|---|---|---|
94644 | Cont inhlj tx 1st hour | 0 | 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.