CPT 94012 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 | • Medicine Services and Procedures • Pulmonary Procedures |
| Common Place of Service | • 50 - Federally Qualified Health Center • 11 - Office |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 26 - Professional component |
| Complexity Level | Low |
National average reimbursement for CPT 94012 by major payers:
$189.00
$190.43
$172.80
$239.68
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 94012 | ||||||
United | 94012 | $255.27 | 1386755486 - DOUGLAS NORDLI | 362177139 - UNIVERSITY OF CHICAGO | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 94012 | $240.05 | 1881937928 - ALEXANDRA AARONSON | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 94012 | $161.47 | 1851376230 - ANITA PAIRITZ | 351913875 - INDIANA UNIVERSITY HEALTH SOUTHERN INDIANA PHYSICIANS | IL | Psychiatry Physician (2084P0800X) |
United | 94012 | $157.19 | 1386969079 - ADAM WALLACE | 362222696 - SWEDISHAMERICAN HOSPITAL | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 94012 | $245.64 | 1952569758 - CHARLES HEBERT | 911780160 | CO | Psychiatry Physician (2084P0800X) |
United | 94012 | $183.42 | 1225171614 - RUBEENA MIAN | 362709982 - (IL) PRESENCE BEHAVIORAL HEALTH | IL | Psychiatry Physician (2084P0800X) |
United | 94012 | $338.23 | 1508937186 - SIGITA PLIOPLYS | 364187449 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 94012 | $305.79 | 1467802108 - MIRIAM BALTUANO SONGHURST | 863284696 - OU HEALTH PARTNERS INC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 94012 | $313.35 | 1851558001 - LUBOV ROMANTSEVA | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 94012 | $292.01 | 1285712851 - MOHAMMAD IKRAMUDDIN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 94012 | $264.45 | 1366883555 - DAVID BANAYAN | 911780160 | TX | Psychiatry Physician (2084P0800X) |
United | 94012 | $271.39 | 1326579756 - TONY TU | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 94012 | $239.44 | 1982268959 - SIDRAH NAJAM | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IN | Psychiatry Physician (2084P0800X) |
United | 94012 | $248.22 | 1780078337 - MATTHEW FILIPPO | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 94012 | $264.45 | 1972984169 - DAVID SHOLTES | 911780160 | 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 94012 vs. Other Pulmonary Procedures Codes
The CPT 94012 code is part of the Medicine Services and Procedures 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 94012 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 |
|---|---|---|
| 94010-CPT | Low | Spirometry, Including Graphic Record, Total And Timed Vital Capacity, Expiratory Flow Rate Measurement(S), With Or Without Maximal Voluntary Ventilation |
| 94011-CPT | Low | Measurement And Graphic Recording Of Total And Timed Exhaled Air Capacity, Infant Or Child Through 2 |
| 94012-CPT | Low | Measurement Of Spirometric Forced Expiratory Flows, Before And After Bronchodilator, In An Infant Or Child Through 2 Years Of Age |
| 94013-CPT | Low | Measurement Of Lung Volumes (Ie Functional Residual Capacity [Frc] Forced Vital Capacity [Fvc] And Expiratory Reserve Volume [Erv] In An Infant Or Child Through 2 Years Of Age |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 94012. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 94012 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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