A Pulmonary Function Test (PFT) is a non-invasive diagnostic procedure that measures how effectively the lungs are working. This series of breathing maneuvers helps physicians evaluate the volume of air the lungs can hold, the rate at which air moves in and out, and how efficiently oxygen enters the bloodstream. PFTs are commonly used to diagnose and monitor conditions such as Chronic Obstructive Pulmonary Disease (COPD) and asthma. The final cost to the patient is highly variable, depending on several factors that influence the final bill.
Defining the Standard Price Range for PFTs
The initial list price, often called the sticker price, for a PFT can span a wide national range, typically falling between $150 and $1,200 for patients without insurance coverage. This significant difference depends primarily on the complexity of the tests performed. The simplest form of PFT is spirometry, which measures how much air a person can exhale and how quickly they can do so. Spirometry often costs on the lower end of the spectrum, sometimes as little as $40 to $100.
A full PFT suite includes additional, more complex measurements that drive the cost higher. These components often include lung volume measurement, which assesses the total amount of air in the lungs, and diffusion capacity testing, which measures the transfer of gas from the lungs to the blood. The combination of these tests requires specialized equipment and more time, accounting for the higher price points. The specific Current Procedural Terminology (CPT) codes billed, such as 94010 for basic spirometry and 94729 for diffusion capacity, directly reflect the complexity of the service provided.
Facility Type and Geographic Variables Affecting Cost
The type of facility where the PFT is administered is one of the largest determinants of the final list price. Hospital outpatient departments generally charge the highest rates, with uninsured costs often ranging from $500 to $1,200. These facilities typically have higher overhead costs, which are reflected in their service pricing.
Independent diagnostic testing facilities and specialized pulmonologist offices usually offer lower rates for the same procedures. Costs at an outpatient clinic might range between $200 and $500, while a local physician’s office can be even lower, around $150 to $350 for an uninsured patient. The lower operating expenses of these smaller centers allow them to set more competitive prices for diagnostic services.
Geographic location also plays a significant role in price variation due to differences in the cost of living and regional competition. PFTs performed in major metropolitan areas or states with a high cost of living generally carry higher price tags than those in rural or less expensive regions.
Understanding Insurance Coverage and Patient Financial Responsibility
The list price of a PFT is rarely the amount a patient with insurance will pay, as the insurer and the provider typically negotiate a much lower rate. This negotiated rate is the actual cost the insurance company agrees to pay the facility for the service, and it is usually far less than the initial amount billed. CPT codes, such as 94060 for spirometry with bronchodilator use, are the standardized system used by providers to bill the insurance company for the exact services rendered.
The patient’s final financial responsibility is determined by the specific structure of their health plan. Deductibles, co-pays, and co-insurance all factor into the final out-of-pocket expense. If a patient has not met their annual deductible, they may be responsible for the full negotiated rate until that threshold is reached. After the deductible is met, the patient may still owe a co-pay (a fixed fee) or co-insurance (a percentage of the service cost).
For more complex or non-routine PFTs, the insurance company may require prior authorization before the test is performed. This confirms that the insurer deems the test medically necessary based on the patient’s symptoms or diagnosis. Failure to obtain this authorization can result in the insurance company refusing to cover the service, leaving the patient responsible for the entire negotiated bill.
Practical Strategies for Minimizing Out-of-Pocket Expense
Patients can take proactive steps to reduce the financial burden associated with a PFT. A primary strategy involves comparison shopping by calling different facilities to inquire about pricing for the specific CPT codes ordered by the physician. Comparing the costs between a large hospital and an independent lab can reveal significant price differences for the exact same test.
Many providers offer significant discounts for patients who are uninsured or who choose to pay out-of-pocket rather than submit a claim to insurance. Asking for a “cash-pay” or “self-pay” rate before the test is scheduled can lead to a substantially lower cost than the billed list price. This upfront payment can often bypass the higher charges associated with insurance billing procedures.
If the bill is still a strain, patients should inquire about financial assistance programs or setting up a monthly payment plan. Many hospitals, particularly non-profit institutions, have financial aid policies that can discount or cover the cost of care for eligible individuals. Patients should also carefully review the itemized bill for any potential errors in coding or duplicate charges before making a payment.