Pulmonary Function Test Cost & Insurance Coverage – A Complete Guide

Introduction

If you’ve been advised to take a Pulmonary Function Test (PFT), you might be wondering about the cost and whether your health insurance or wellness plan covers it. PFTs are essential for diagnosing lung conditions like asthma, COPD, and pulmonary fibrosis, but their cost can vary widely.

In this comprehensive guide, we’ll break down:

• The average cost of a Pulmonary Function Test

• Factors influencing PFT pricing

• Insurance coverage for PFTs

• Ways to reduce out-of-pocket expenses

• FAQs about Pulmonary Function Tests

By the end, you’ll have a clear understanding of what to expect financially when scheduling a PFT.

What is a Pulmonary Function Test (PFT)?

A Pulmonary Function Test is a non-invasive diagnostic procedure that measures how well your lungs work. It evaluates:

• Lung capacity (how much air your lungs can hold)

• Airflow rates (how quickly you can inhale and exhale)

• Gas exchange efficiency (how well oxygen enters your blood)

PFTs help diagnose conditions like:
✅ Asthma
✅ Chronic Obstructive Pulmonary Disease (COPD)
✅ Pulmonary fibrosis
✅ Bronchiectasis
✅ Pre-surgical lung assessment

Given its diagnostic importance, understanding the cost and insurance coverage is crucial.

Average Cost of a Pulmonary Function Test

The cost of a Pulmonary Function Test varies based on:

• Location (hospital vs. independent lab)

• Type of PFT (basic spirometry vs. full PFT panel)

• Healthcare provider fees

1. Standard Spirometry Test Cost

• $100–$300 (without insurance)

• Measures forced vital capacity (FVC) and forced expiratory volume (FEV1)

2. Complete PFT Panel Cost

• $300–$800+ (without insurance)

• Includes spirometry, lung volume tests, and diffusion capacity tests

3. Hospital vs. Independent Clinic Pricing

• Hospitals charge more due to facility fees ($500–$1,500)

• Independent clinics or pulmonology offices may offer lower rates ($200–$600)

4. Additional Costs to Consider

• Consultation fees ($100–$300) if referred by a specialist

• Follow-up tests if initial results are inconclusive

Does Health Insurance Cover Pulmonary Function Tests?

Most health insurance plans cover PFTs if deemed medically necessary. Here’s what you need to know:

1. Medicare Coverage for PFTs

• Part B covers PFTs if ordered by a doctor for diagnosis or monitoring.

• Typically covers 80% of the Medicare-approved amount after the deductible.

2. Medicaid Coverage

• Varies by state but generally covers PFTs for qualifying conditions.

3. Private Insurance (UnitedHealthcare, Blue Cross, Aetna, etc.)

• Most PPO and HMO plans cover PFTs with a copay ($20–$50) or coinsurance (10% – 30%).

• Prior authorization may be required.

4. Wellness Plans & Employer-Sponsored Health Programs

• Some corporate wellness plans include screening tests like spirometry.

• Check if your employer offers preventive care benefits.

5. When Insurance Might Deny Coverage

• If the test is considered not medically necessary (e.g., for general screening without symptoms).

• If performed at an out-of-network facility.

Pro Tip: Always verify coverage with your insurer before scheduling a PFT.

How to Reduce the Cost of a Pulmonary Function Test

If you’re paying out-of-pocket, here are ways to save:

1. Compare Prices

• Use healthcare price comparison tools (e.g., Healthcare Bluebook) to find affordable providers.

2. Choose an Independent Lab Over a Hospital

• Hospitals have higher facility fees—clinics often offer lower rates.

3. Ask About Cash Discounts

• Some providers offer 20% – 40% discounts for self-pay patients.

4. Check for Financial Assistance Programs

• Nonprofits and hospitals may offer sliding-scale fees based on income.

5. Use an HSA or FSA

• Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) can cover PFT costs tax-free.

FAQs About Pulmonary Function Test Costs

1. How much does a PFT cost with insurance?

• With insurance, you may pay only a copay ($20–$50) or coinsurance (10% – 30%).

2. Is a PFT worth the cost?

• Yes, if you have symptoms like chronic cough or shortness of breath—early diagnosis can prevent complications.

3. Can I get a PFT without a doctor’s referral?

• Most insurers require a doctor’s order for coverage.

4. How often should I get a PFT?

• Depends on your condition—asthma/COPD patients may need annual tests.

5. Are home spirometry tests accurate?

• Basic home spirometers can track lung function but aren’t as precise as clinical PFTs.

Conclusion: Is a Pulmonary Function Test Affordable?

The cost of a Pulmonary Function Test ranges from $100to$1,500, depending on complexity and location. Fortunately, most health insurance plans cover PFTs when medically necessary.