CPT 94005 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Ventilator Management Pulmonary Procedures |
| Common Place of Service | 22 - On Campus Outpatient Hospital 11 - Office 21 - Inpatient Hospital |
| Common Modifiers | None 25 - Significant, separately identifiable E/M service same day 95 - Telemedicine - audio and video |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 94005 |
National average reimbursement for CPT 94005 by major payers:
$119.25
$115.90
$110.65
$154.44
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 94005 | $195.63 | 1841721925 - CHELSEA CURRY | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 94005 | $85.97 | 1720344229 - KERRY COOK | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Medical Physician Assistant (363AM0700X) |
United | 94005 | $63.22 | 1205975448 - CHRISTOPHER JOHNSON | 371158318 - (IL) SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC | IL | Psychiatry Physician (2084P0800X) |
United | 94005 | $191.80 | 1821097924 - AFTAB POSHNI | 363994258 - (IL) HORIZONS BEHAVIORAL HEALTH LLC | IL | Psychiatry Physician (2084P0800X) |
United | 94005 | $124.05 | 1386969079 - ADAM WALLACE | 363907436 - ROCKFORD HEALTH PHYSICIANS | WI | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 94005 | $201.00 | 1013173699 - REBECCA O'DONNELL | 364187449 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 94005 | $143.83 | 1679739395 - BETSY OSTRANDER | 810232122 - BENEFIS HOSPITALS INC | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 94005 | $183.05 | 1881918415 - TUSHAR ADVANI | 910844563 | MT | Psychiatry Physician (2084P0800X) |
United | 94005 | $183.52 | 1730263617 - MARK ALTER | 811324691 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 94005 | $183.05 | 1730263617 - MARK ALTER | 910844563 | WI | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 94005 | $165.97 | 1568921476 - YU ZHANG | 363097297 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 94005 | $84.59 | 1215410873 - MACY BOSSHARD | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Physician Assistant (363A00000X) |
United | 94005 | $135.50 | 1679739395 - BETSY OSTRANDER | 942854057 - IHC HEALTH SERVICES INC | UT | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 94005 | $226.61 | 1992122410 - DIVAKAR MITHAL | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 94005 | $141.63 | 1710914890 - ADNAN ARIF | 363149833 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 94005 vs. Other Pulmonary Procedures Codes
The CPT 94005 code is part of the Ventilator Management services used for Pulmonary Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 94005 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 94005-CPT | Low | Home Vent Mgmt Supervision, Home Ventilator Management Care Plan Oversight Of A Patient Patient Not Present In Home Domiciliary Or Rest Home Eg Assisted Living Requiring Review Of Status Review Of Laboratories And Other Studies And Revision Of Orders And Respiratory Care Plan As Appropriate Within A Calendar Month 30 Minutes Or More |
| 94010-CPT | Low | Spirometry Including Graphic, Spirometry Including Graphic Record Total And Timed Vital Capacity Expiratory Flow Rate Measurement(S) With Or Without Maximal Voluntary Ventilation |
| 94011-CPT | Low | Spirometer Breath Test, This Test Involves Breathing Out Hard Into A Spirometer (Device For Measuring Airflow). The Spirometer Records The Amount And Rate Of Airflow. |
| 94060-CPT | Low | Breathing Test With Medication, Test To See How Well A Medication For Increasing Airflow To The Lungs (Bronchodilator) Works. The Person Breathes Into A Spirometer (Device For Measuring Airflow) Before Using The Medicine And Then Afterward. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 94005. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 94005 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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