CPT 94003
Global XXX ActiveVent mgmt inpat subq day
CPT 94003 Billing & Documentation Guide
CPT code 94003 (Vent mgmt inpat subq day) is classified under Pulmonary with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.37, a non-facility practice expense RVU of 0.28, and a malpractice RVU of 0.12, a total non-facility RVU of 1.77 and facility RVU of 1.77. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $59.89, though rates vary from $55.86 to $80.81 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 94003, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 94003 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 94003 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 94003
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.37 | 1.37 |
| Practice Expense RVU | 0.28 | 0.28 |
| Malpractice RVU | 0.12 | 0.12 |
| Total RVU | 1.77 | 1.77 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 94003
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $60.64 | $60.64 | $58.94 - $66.43 | 29 |
| Florida | $62.94 | $62.94 | $60.72 - $65.63 | 3 |
| Georgia | $59.55 | $59.55 | $58.88 - $60.21 | 2 |
| Illinois | $62.62 | $62.62 | $60.56 - $64.68 | 4 |
| Michigan | $60.18 | $60.18 | $58.82 - $61.54 | 2 |
| North Carolina | $57.05 | $57.05 | $57.05 - $57.05 | 1 |
| New York | $63.81 | $63.81 | $57.46 - $67.25 | 5 |
| Ohio | $58.34 | $58.34 | $58.34 - $58.34 | 1 |
| Pennsylvania | $59.62 | $59.62 | $58.13 - $61.1 | 2 |
| Texas | $58.94 | $58.94 | $57.99 - $60.93 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 94003
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 94003 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 00520 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 94004 | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 94375 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 94400 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 94450 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 94660 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 94662 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 96523 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 94003
What does CPT code 94003 mean? +
CPT code 94003 represents: Vent mgmt inpat subq day. It's in the Pulmonary category with a global period of XXX.
What is the Medicare reimbursement for CPT 94003? +
The 2026 Medicare national average non-facility payment for CPT 94003 is $59.89. Rates range from $55.86 to $80.81 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 94003? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 94003? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team