CPT 94004
Global XXX ActiveVent mgmt nf per day
CPT 94004 Billing & Documentation Guide
CPT code 94004 (Vent mgmt nf per day) is classified under Pulmonary with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1, a non-facility practice expense RVU of 0.24, and a malpractice RVU of 0.07, a total non-facility RVU of 1.31 and facility RVU of 1.31. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $44.45, though rates vary from $41.49 to $59.93 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 94004, 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 94004 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 94004 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 94004
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1 | 1 |
| Practice Expense RVU | 0.24 | 0.24 |
| Malpractice RVU | 0.07 | 0.07 |
| Total RVU | 1.31 | 1.31 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 94004
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 | $45.35 | $45.35 | $44.01 - $49.89 | 29 |
| Florida | $46 | $46 | $44.58 - $47.66 | 3 |
| Georgia | $43.9 | $43.9 | $43.34 - $44.45 | 2 |
| Illinois | $45.73 | $45.73 | $44.37 - $47.06 | 4 |
| Michigan | $44.22 | $44.22 | $43.36 - $45.08 | 2 |
| North Carolina | $42.37 | $42.37 | $42.37 - $42.37 | 1 |
| New York | $47.11 | $47.11 | $42.66 - $49.41 | 5 |
| Ohio | $43.08 | $43.08 | $43.08 - $43.08 | 1 |
| Pennsylvania | $44.06 | $44.06 | $42.97 - $45.14 | 2 |
| Texas | $43.65 | $43.65 | $42.87 - $44.85 | 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 94004
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 94004 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 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 |
| 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 |
| 00100 | Column 2 (secondary), bundled into primary | Yes | Standard preparation/monitoring services for anesthesia |
| 00102 | Column 2 (secondary), bundled into primary | Yes | Standard preparation/monitoring services for anesthesia |
Frequently Asked Questions, CPT 94004
What does CPT code 94004 mean? +
CPT code 94004 represents: Vent mgmt nf per day. It's in the Pulmonary category with a global period of XXX.
What is the Medicare reimbursement for CPT 94004? +
The 2026 Medicare national average non-facility payment for CPT 94004 is $44.45. Rates range from $41.49 to $59.93 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 94004? +
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 94004? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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