CPT 94010
Global XXX ActiveBreathing capacity test
CPT 94010 Billing & Documentation Guide
CPT code 94010 (Breathing capacity test) is classified under Pulmonary with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.17, a non-facility practice expense RVU of 0.7, and a malpractice RVU of 0.02, a total non-facility RVU of 0.89 and facility RVU of 0.89. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $30.77, though rates vary from $26.11 to $40.38 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 94010, 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 94010 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 94010 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 94010
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.17 | 0.17 |
| Practice Expense RVU | 0.7 | 0.7 |
| Malpractice RVU | 0.02 | 0.02 |
| Total RVU | 0.89 | 0.89 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 94010
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 | $33.91 | $33.91 | $31.76 - $40.38 | 29 |
| Florida | $30.44 | $30.44 | $29.03 - $31.71 | 3 |
| Georgia | $28.79 | $28.79 | $27.33 - $30.25 | 2 |
| Illinois | $29.56 | $29.56 | $28.07 - $30.91 | 4 |
| Michigan | $28.58 | $28.58 | $27.78 - $29.37 | 2 |
| North Carolina | $27.92 | $27.92 | $27.92 - $27.92 | 1 |
| New York | $32.94 | $32.94 | $28.36 - $35.08 | 5 |
| Ohio | $27.7 | $27.7 | $27.7 - $27.7 | 1 |
| Pennsylvania | $29.35 | $29.35 | $27.77 - $30.92 | 2 |
| Texas | $29.35 | $29.35 | $27.58 - $31.02 | 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 94010
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 94010 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 |
| 0243T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 0244T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 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 |
| 94150 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 94150 | Column 1 (primary), can be billed with modifier | 9 | CPT Separate procedure definition |
| 94160 | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 94200 | Column 1 (primary), can be billed with modifier | Yes | HCPCS/CPT procedure code definition |
| 94375 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 94010
What does CPT code 94010 mean? +
CPT code 94010 represents: Breathing capacity test. It's in the Pulmonary category with a global period of XXX.
What is the Medicare reimbursement for CPT 94010? +
The 2026 Medicare national average non-facility payment for CPT 94010 is $30.77. Rates range from $26.11 to $40.38 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 94010? +
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 94010? +
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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