CPT 94200 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 | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 26 - Professional component |
| Complexity Level | Low |
National average reimbursement for CPT 94200 by major payers:
$21.74
$29.08
$25.68
$30.77
| 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 94200 | ||||||
United | 94200 | $37.88 | 1952795254 - MALCOLM VANDREVALA | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 94200 | $32.97 | 1730246067 - SENADA BAJMAKOVIC-KACILA | 911780160 | IL | Psychiatry Physician (2084P0800X) |
United | 94200 | $7.34 | 1265883375 - JOCELYN LORENZO | 274026658 | LA | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 94200 | $42.47 | 1760412621 - RHONDA LAMPEN | 811324691 | MI | Psychiatry Physician (2084P0800X) |
United | 94200 | $19.03 | 1851376230 - ANITA PAIRITZ | 351913875 - INDIANA UNIVERSITY HEALTH SOUTHERN INDIANA PHYSICIANS | IN | Psychiatry Physician (2084P0800X) |
United | 94200 | $24.20 | 1902440969 - WANDA CEGERS | 362743287 - TCA HEALTH INC NFP | IL | Psychiatry Physician (2084P0800X) |
United | 94200 | $33.83 | 1386969079 - ADAM WALLACE | 362222696 - SWEDISHAMERICAN HOSPITAL | WI | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 94200 | $34.43 | 1154749844 - NORA EKEANYA | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | CA | Psychiatry Physician (2084P0800X) |
United | 94200 | $29.85 | 1114472867 - MARCUS BYRD | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 94200 | $43.70 | 1063972404 - MAANASA BANDLA | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | VA | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 94200 | $12.18 | 1962791343 - JEREMY WONG | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 94200 | $31.51 | 1952387318 - MELANY DANEHY | 363097297 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 94200 | $29.96 | 1932309325 - MEHDI QALBANI | 852340442 | IL | Psychiatry Physician (2084P0800X) |
United | 94200 | $15.25 | 1578767935 - FABIAN CARBONELL MD SC | 364336222 - (IL) FABIAN CARBONELL MD SC | IL | Psychiatry Physician (2084P0800X) |
United | 94200 | $24.20 | 1851390637 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
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 94200 vs. Other Pulmonary Procedures Codes
The CPT 94200 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 94200 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 |
|---|---|---|
| 94150-CPT | Low | Test To Measure The Total Volume Of Air That Can Be Exhaled After Inhaling |
| 94200-CPT | Low | Measurement Of Largest Amount Of Air Breathed In An Out Of Lungs Over One Minute |
| 94375-CPT | Low | Respiratory Flow Volume Loop |
| 94640-CPT | Low | Pressurized Or Nonpressurized Inhalation Treatmentfor Acute Airway Obstruction For Therapeutic Purposes And/Or For Diagnostic Purposes (Such As Sputum Induction With An Aerosol Generator Nebulizer Metered Dose Inhaler Or Intermittent Positive Pressure Breathing (Ippb) Device) (Desc Revised 01/01/2016) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 94200. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 94200 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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