CPT 94680
Global XXX ActiveO2 uptk rst&xers dir simple
CPT 94680 Billing & Documentation Guide
CPT code 94680 (O2 uptk rst&xers dir simple) is classified under Pulmonary with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.25, a non-facility practice expense RVU of 1.45, and a malpractice RVU of 0.03, a total non-facility RVU of 1.73 and facility RVU of 1.73. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $59.92, though rates vary from $50.47 to $79.64 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 94680, 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 94680 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 94680 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 94680
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.25 | 0.25 |
| Practice Expense RVU | 1.45 | 1.45 |
| Malpractice RVU | 0.03 | 0.03 |
| Total RVU | 1.73 | 1.73 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 94680
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 | $66.5 | $66.5 | $62.11 - $79.64 | 29 |
| Florida | $58.89 | $58.89 | $56.16 - $61.3 | 3 |
| Georgia | $55.77 | $55.77 | $52.75 - $58.78 | 2 |
| Illinois | $57.09 | $57.09 | $54.13 - $59.92 | 4 |
| Michigan | $55.24 | $55.24 | $53.7 - $56.78 | 2 |
| North Carolina | $54.18 | $54.18 | $54.18 - $54.18 | 1 |
| New York | $64.14 | $64.14 | $55.06 - $68.33 | 5 |
| Ohio | $53.58 | $53.58 | $53.58 - $53.58 | 1 |
| Pennsylvania | $56.94 | $56.94 | $53.76 - $60.11 | 2 |
| Texas | $57.01 | $57.01 | $53.35 - $60.5 | 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 94680
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 94680 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0543T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0544T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0548T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0567T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0568T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0569T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0570T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0571T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0572T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0573T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 94680
What does CPT code 94680 mean? +
CPT code 94680 represents: O2 uptk rst&xers dir simple. It's in the Pulmonary category with a global period of XXX.
What is the Medicare reimbursement for CPT 94680? +
The 2026 Medicare national average non-facility payment for CPT 94680 is $59.92. Rates range from $50.47 to $79.64 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 94680? +
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 94680? +
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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