CPT 94450
Global XXX ActiveBreathing response hypoxia
CPT 94450 Billing & Documentation Guide
CPT code 94450 (Breathing response hypoxia) is classified under Pulmonary with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.39, a non-facility practice expense RVU of 2.97, and a malpractice RVU of 0.04, a total non-facility RVU of 3.4 and facility RVU of 3.4. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $117.97, though rates vary from $98.93 to $158.22 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 94450, 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 94450 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 94450 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 94450
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.39 | 0.39 |
| Practice Expense RVU | 2.97 | 2.97 |
| Malpractice RVU | 0.04 | 0.04 |
| Total RVU | 3.4 | 3.4 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 94450
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 | $131.6 | $131.6 | $122.69 - $158.22 | 29 |
| Florida | $115.16 | $115.16 | $109.87 - $119.67 | 3 |
| Georgia | $109.29 | $109.29 | $103.11 - $115.46 | 2 |
| Illinois | $111.48 | $111.48 | $105.68 - $117.36 | 4 |
| Michigan | $108.06 | $108.06 | $105.1 - $111.01 | 2 |
| North Carolina | $106.43 | $106.43 | $106.43 - $106.43 | 1 |
| New York | $126.13 | $126.13 | $108.21 - $134.29 | 5 |
| Ohio | $104.94 | $104.94 | $104.94 - $104.94 | 1 |
| Pennsylvania | $111.74 | $111.74 | $105.36 - $118.12 | 2 |
| Texas | $112 | $112 | $104.54 - $119.19 | 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 94450
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 94450 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 |
| 94200 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 94400 | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 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 |
Frequently Asked Questions, CPT 94450
What does CPT code 94450 mean? +
CPT code 94450 represents: Breathing response hypoxia. It's in the Pulmonary category with a global period of XXX.
What is the Medicare reimbursement for CPT 94450? +
The 2026 Medicare national average non-facility payment for CPT 94450 is $117.97. Rates range from $98.93 to $158.22 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 94450? +
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 94450? +
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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