How Much Does Physician/qualified Health Professional Outpatient Pulm Rhb without Mntr Cost?
Also known as: Phy/qhp op pulm rhb w/o mntr (CPT 94625)
A pulmonary rehabilitation session combining exercise training, education, and breathing techniques for people with lung disease.
Physician/qualified Health Professional Outpatient Pulm Rhb without Mntr (CPT 94625) costs $16 at Medicare rates.
Patient Guide: Physician/qualified Health Professional Outpatient Pulm Rhb without Mntr
What you need to know before your appointment
What to Expect
You will participate in supervised exercise (treadmill, bike, weights), learn breathing techniques, and receive education about managing your lung condition. Oxygen levels are monitored.
How Long Does It Take?
60-90 minutes per session; typically 2-3 times per week for 6-12 weeks
Common Reasons Doctors Order This
COPD, pulmonary fibrosis, before or after lung surgery, chronic asthma, shortness of breath with daily activities
How to Prepare
Wear comfortable clothing and walking shoes. Bring your inhalers. Eat a light meal 2 hours before. Bring your supplemental oxygen if you use it.
Procedures Commonly Done Together
These procedures are frequently performed alongside Phy/qhp op pulm rhb w/o mntr
How to Reduce Your Cost for Phy/qhp op pulm rhb w/o mntr
Practical tips that can save you hundreds or thousands of dollars
- 1 Ask about cash-pay discounts
Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.
- 2 Compare facility vs. office setting costs
For this procedure, the office rate ($87) differs from the facility rate ($16). Ask if it can be done in an office setting.
- 3 Shop around — costs vary significantly
Costs can vary 2-3x between providers in the same city. Get quotes from multiple facilities.
How is the Price Calculated?
Medicare calculates procedure payments using Relative Value Units (RVUs). Each procedure has three components multiplied by a conversion factor ($33.40 in 2026) and adjusted by geographic cost indices.
Payment = Total RVU (2.61) x CF ($33.40) = $87
Related Procedures
Similar procedures in the same category or body system
Frequently Asked Questions
How much does Phy/qhp op pulm rhb w/o mntr cost?
The Medicare facility rate for Phy/qhp op pulm rhb w/o mntr is $16. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).
How much does Phy/qhp op pulm rhb w/o mntr cost without insurance?
Without insurance, the cost of Phy/qhp op pulm rhb w/o mntr can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.
Does insurance cover Phy/qhp op pulm rhb w/o mntr?
Most commercial health insurance plans and Medicare cover Phy/qhp op pulm rhb w/o mntr when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.
Why does the cost vary so much by location?
Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.