CPT 94375
Global XXX ActiveRespiratory flow volume loop
CPT 94375 Billing & Documentation Guide
CPT code 94375 (Respiratory flow volume loop) is classified under Pulmonary with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.3, a non-facility practice expense RVU of 0.94, and a malpractice RVU of 0.02, a total non-facility RVU of 1.26 and facility RVU of 1.26. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $43.56, though rates vary from $37.33 to $56.75 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 94375, 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 94375 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 94375 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 94375
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.3 | 0.3 |
| Practice Expense RVU | 0.94 | 0.94 |
| Malpractice RVU | 0.02 | 0.02 |
| Total RVU | 1.26 | 1.26 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 94375
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 | $47.89 | $47.89 | $44.96 - $56.75 | 29 |
| Florida | $42.82 | $42.82 | $41.04 - $44.39 | 3 |
| Georgia | $40.79 | $40.79 | $38.82 - $42.75 | 2 |
| Illinois | $41.67 | $41.67 | $39.73 - $43.52 | 4 |
| Michigan | $40.44 | $40.44 | $39.44 - $41.44 | 2 |
| North Carolina | $39.74 | $39.74 | $39.74 - $39.74 | 1 |
| New York | $46.43 | $46.43 | $40.32 - $49.23 | 5 |
| Ohio | $39.36 | $39.36 | $39.36 - $39.36 | 1 |
| Pennsylvania | $41.58 | $41.58 | $39.47 - $43.68 | 2 |
| Texas | $41.61 | $41.61 | $39.21 - $43.85 | 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 94375
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 94375 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 |
| 94150 | Column 1 (primary), can be billed with modifier | 9 | CPT Separate procedure definition |
| 94728 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 96523 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 99201 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 99201 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 99202 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 99202 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 94375
What does CPT code 94375 mean? +
CPT code 94375 represents: Respiratory flow volume loop. It's in the Pulmonary category with a global period of XXX.
What is the Medicare reimbursement for CPT 94375? +
The 2026 Medicare national average non-facility payment for CPT 94375 is $43.56. Rates range from $37.33 to $56.75 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 94375? +
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 94375? +
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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