2026 billing guide · Pulm

Pulmonology, coding reference.

Office spirometry, pulmonary function testing, bronchoprovocation, sleep medicine. Spirometry is one of the most under-coded ancillaries in primary-care-adjacent practices because the bronchodilator add-on gets forgotten.

Featured code
99214
1.92 wRVU each
Top codes covered
10

Selected reference codes

A curated selection, not a utilization ranking. Open a code for documentation requirements, modifiers, and pitfalls.

CodeDescriptionwRVUTotal RVUMedicare $
99214Office o/p est mod 30 min
99214 is the workhorse of primary care and most outpatient subspecialties. Use it when at least one of these is true: two or more chronic problems with progression, treatment changes, or side effects; one undiagnosed new problem with uncertain prognosis; one acute illness with systemic symptoms; or prescription drug management at any complexity. Prescription drug management on its own satisfies the moderate-risk element, which is why straightforward chronic disease follow-ups with a med adjustment routinely clear the 99214 bar. Time-based alternative is 30 to 39 minutes of total time on the date of the encounter. Pick the method that supports the strongest note: encounters with prescription changes are usually cleaner under MDM; encounters with extensive counseling or care coordination are usually cleaner under time.
1.924.06136Details →
99215Office o/p est hi 40 min
Select this level when at least two of the three MDM elements meet high complexity, or when qualifying total time reaches 40 minutes. A diagnosis, medication, or high-risk decision alone does not establish the overall level. For Medicare prolonged services with this time-selected base code, the first G2212 unit requires 69 minutes. Payers recognizing CPT 99417 use different thresholds.
2.805.76192Details →
94010Breathing capacity test
Baseline office spirometry. Use 94060 if you give bronchodilator and repeat.
0.170.8930Details →
94060Evaluation of wheezing
Pre- and post-bronchodilator spirometry. The 'asthma confirmation' code.
0.211.3043Details →
94375Respiratory flow volume loop
Flow-volume loop testing for upper-airway obstruction evaluation.
0.301.2642Details →
94640Airway inhalation treatment
In-office nebulized albuterol or saline induction.
0.000.269Details →
94660Cpap initiation&mgmt
CPAP initiation visit or follow-up management.
0.742.0769Details →
95810Polysom 6/> yrs 4/> param
In-lab attended polysomnography. Use 95811 if titration also performed.
2.4420.17674Details →
95806Sleep study unatt&resp efft
Home sleep apnea test (unattended).
0.913.09103Details →
94726Plethysmography lung volumes
Body plethysmography for TLC, RV, FRC measurement (full PFT).
0.251.9164Details →
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Verify the individual services

These educational examples are not approved claim bundles. Listed codes may be alternatives. Check the actual service, current code-pair edits, payer coverage, timing and documentation before reporting.

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Educational reference, not billing or legal advice. Coverage curated, not exhaustive. Verify against payer contracts.