CPT 94621
Global XXX ActiveCardiopulm exercise testing
CPT 94621 Billing & Documentation Guide
CPT code 94621 (Cardiopulm exercise testing) is classified under Pulmonary with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.38, a non-facility practice expense RVU of 3.49, and a malpractice RVU of 0.09, a total non-facility RVU of 4.96 and facility RVU of 4.96. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $171.26, though rates vary from $147.77 to $220.87 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 94621, 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 94621 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 94621 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 94621
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.38 | 1.38 |
| Practice Expense RVU | 3.49 | 3.49 |
| Malpractice RVU | 0.09 | 0.09 |
| Total RVU | 4.96 | 4.96 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 94621
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 | $187.31 | $187.31 | $176.25 - $220.87 | 29 |
| Florida | $168.9 | $168.9 | $162.05 - $175.04 | 3 |
| Georgia | $160.97 | $160.97 | $153.66 - $168.28 | 2 |
| Illinois | $164.64 | $164.64 | $157.22 - $171.46 | 4 |
| Michigan | $159.78 | $159.78 | $155.91 - $163.65 | 2 |
| North Carolina | $156.77 | $156.77 | $156.77 - $156.77 | 1 |
| New York | $182.41 | $182.41 | $158.95 - $193.23 | 5 |
| Ohio | $155.55 | $155.55 | $155.55 - $155.55 | 1 |
| Pennsylvania | $163.9 | $163.9 | $155.94 - $171.86 | 2 |
| Texas | $163.9 | $163.9 | $154.96 - $172.18 | 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 94621
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 94621 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 |
| 0178T | Column 1 (primary), can be billed with modifier | Yes | HCPCS/CPT procedure code definition |
| 0179T | Column 1 (primary), can be billed with modifier | Yes | HCPCS/CPT procedure code definition |
| 0180T | Column 1 (primary), can be billed with modifier | Yes | HCPCS/CPT procedure code definition |
| 0243T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0244T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | HCPCS/CPT procedure code definition |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | HCPCS/CPT procedure code definition |
| 0905T | Column 1 (primary), can be billed with modifier | Yes | HCPCS/CPT procedure code definition |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 94621
What does CPT code 94621 mean? +
CPT code 94621 represents: Cardiopulm exercise testing. It's in the Pulmonary category with a global period of XXX.
What is the Medicare reimbursement for CPT 94621? +
The 2026 Medicare national average non-facility payment for CPT 94621 is $171.26. Rates range from $147.77 to $220.87 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 94621? +
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 94621? +
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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