CPT 94375 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 |
| Medicare Fee Schedule | View Medicare rates for 94375 |
National average reimbursement for CPT 94375 by major payers:
$47.39
$49.32
$51.00
$63.25
| 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 94375 | ||||||
United | 94375 | $91.23 | 1730356015 - ASHLEI MATHEW | 134000192 - ENT AND ALLERGY ASSOCIATES, LLP | NY | Allergy & Immunology Physician (207K00000X) |
United | 94375 | $21.95 | 1235151275 - ALLERGY & IMMUNOLOGY MEDICAL GROUP | 953382308 - (CA) ALLERGY & IMMUNOLOGY MEDICAL GROUP | CA | Allergy Physician (207KA0200X) |
United | 94375 | $15.48 | 1861495988 - EVA JAKABOVICS | 232732675 - (PA) ALLERGY AND ASTHMA SPECIALISTS, PC | PA | Allergy & Immunology Physician (207K00000X) |
United | 94375 | $20.95 | 1215039037 - BRIAN NOVICK | 112923819 - (NY) BRIAN E NOVICK MD PC DBA ALLERGY TESTING CENTER | NY | Allergy Physician (207KA0200X) |
United | 94375 | $45.75 | 1730397498 - NORTHERN NEVADA ALLERGY CLINIC, LTD., NORTHERN NEVADA ALLERGY CLINIC | 1730397498 - (NV) NORTHERN NEVADA ALLERGY CLINIC, LTD. | NV | Allergy Physician (207KA0200X) |
United | 94375 | $18.12 | 1538163423 - MARC SICKLICK | 1538163423 - (NY) MARC SICKLICK | NY | Allergy Physician (207KA0200X) |
United | 94375 | $36.88 | 1912056243 - PENINSULA ALLERGY & ASTHMA ASSOCIATES P A | 521164001 - (MD) PENINSULA ALLERGY ASTHMA ASSOCIATES P A | MD | Allergy & Immunology Physician (207K00000X) |
United | 94375 | $22.26 | 1407349442 - SARAH NIMRI | 760459500 - U T PHYSICIANS | TX | Allergy & Immunology Physician (207K00000X) |
United | 94375 | $28.00 | 1194795450 - MCGOVERN ALLERGY CLINIC, P.A., MCGOVERN ALLERGY AND ASTHMA CLINIC, P.A. | 760084676 - (TX) MCGOVERN ALLERGY & ASTHMA CLINIC PA | TX | Clinical & Laboratory Immunology (Allergy & Immunology) Physician (207KI0005X) |
United | 94375 | $22.48 | 1649347014 - ALLERGY & ASTHMA AFFILIATES, INC. | 50521824 - (VA) ALLERGY & ASTHMA AFFILIATES, INC. | VA | Allergy Physician (207KA0200X) |
United | 94375 | $41.72 | 1063528321 - ALAN GOLDSOBEL | 471370520 | CA | Allergy & Immunology Physician (207K00000X) |
United | 94375 | $18.40 | 1407935281 - JAMES KIDD | 720973149 | LA | Allergy & Immunology Physician (207K00000X) |
United | 94375 | $20.45 | 1811335607 - ANITA KALLEPALLI | 942579303 - (CA) AAAPMG INC. | CA | Allergy & Immunology Physician (207K00000X) |
United | 94375 | $17.44 | 1003348004 - SUSAMITA KESH | 752497016 - (TX) FAAC, P.A. | TX | Allergy & Immunology Physician (207K00000X) |
United | 94375 | $32.95 | 1568491876 - VICKI TEPPER | 521182593 - (MD) UNIVERSITY OF MARYLAND PEDIATRIC AS SOCIATES P A | MD | Pediatric Allergy/Immunology Physician (2080P0201X) |
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 94375 vs. Other Pulmonary Procedures Codes
The CPT 94375 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 94375 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 |
| 94375-CPT | Low | Respiratory Flow Volume Loop |
| 94450-CPT | Low | Breathing Response To Hypoxia |
| 94644-CPT | Low | Continuous Inhalation Treatment With Aerosol Medication For Acute Airway Obstruction First Hour |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 94375. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 94375 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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