CPT 94626
Global XXX ActivePhy/qhp op pulm rhb w/mntr
CPT 94626 Billing & Documentation Guide
CPT code 94626 (Phy/qhp op pulm rhb w/mntr) is classified under Pulmonary with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.56, a non-facility practice expense RVU of 2.64, and a malpractice RVU of 0.07, a total non-facility RVU of 3.27 and facility RVU of 0.73. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $113.11, though rates vary from $95.65 to $149.17 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 94626, 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 94626 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 2 units of 94626 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 94626
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.56 | 0.56 |
| Practice Expense RVU | 2.64 | 0.1 |
| Malpractice RVU | 0.07 | 0.07 |
| Total RVU | 3.27 | 0.73 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 94626
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 | $124.98 | $24.6 | $116.92 - $149.17 | 29 |
| Florida | $111.73 | $26.61 | $106.52 - $116.41 | 3 |
| Georgia | $105.66 | $24.72 | $100.15 - $111.16 | 2 |
| Illinois | $108.44 | $26.47 | $102.87 - $113.54 | 4 |
| Michigan | $104.79 | $25.13 | $101.85 - $107.74 | 2 |
| North Carolina | $102.47 | $23.31 | $102.47 - $102.47 | 1 |
| New York | $121.14 | $26.49 | $104.12 - $129.09 | 5 |
| Ohio | $101.57 | $24.11 | $101.57 - $101.57 | 1 |
| Pennsylvania | $107.74 | $24.65 | $101.86 - $113.62 | 2 |
| Texas | $107.79 | $24.27 | $101.12 - $114.11 | 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 94626
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 94626 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | 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 |
| 12001 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 12002 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 12004 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 12005 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 12006 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 94626
What does CPT code 94626 mean? +
CPT code 94626 represents: Phy/qhp op pulm rhb w/mntr. It's in the Pulmonary category with a global period of XXX.
What is the Medicare reimbursement for CPT 94626? +
The 2026 Medicare national average non-facility payment for CPT 94626 is $113.11. Rates range from $95.65 to $149.17 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 94626? +
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 94626? +
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 June 2, 2026.
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