CPT 94453 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 | • 22 - On Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • 26 - Professional component • 59 - Distinct Procedural Service |
| Complexity Level | Low |
National average reimbursement for CPT 94453 by major payers:
$85.19
$94.75
$92.85
$125.01
| 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 94453 | ||||||
United | 94453 | $137.46 | 1770014920 - JOSEPH PEPITONE | 363738206 - NORTHSHORE UNIVERSITY HEALTHSYSTEM FACULTY PRACTICE ASSOCIATES | IL | Psychiatry Physician (2084P0800X) |
United | 94453 | $40.20 | 1578957676 - LAURA VERNON | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | NY | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 94453 | $101.48 | 1548279870 - VINOD ALLURI | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | TX | Psychiatry Physician (2084P0800X) |
United | 94453 | $84.66 | 1033640198 - ABDULLAH BIN MAHFODH | 815143225 - (IL) COMMUNITY HOME PHYSICIANS LLC D/B/A COMMUNITY PHYSICIANS | IL | Psychiatry Physician (2084P0800X) |
United | 94453 | $22.68 | 1679968697 - JEREMIAH BREWER | 910843135 | TX | Psychiatry Physician (2084P0800X) |
United | 94453 | $56.41 | 1225058332 - SHERRIE LEVY | 371140016 - CARLE HEALTH CARE INCORPORATED | IL | Psychiatry Physician (2084P0800X) |
United | 94453 | $20.35 | 1063891232 - BIKRAM SHARMA | 364340137 - (IL) SAINT ANTHONY HEALTH AFFILIATES | IL | Psychiatry Physician (2084P0800X) |
United | 94453 | $124.66 | 1477074060 - OLATOLA IYI-OJO | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | IL | Psychiatry Physician (2084P0800X) |
United | 94453 | $103.69 | 1710206545 - NEIL JARIWALA | 910844563 | GA | Psychiatry Physician (2084P0800X) |
United | 94453 | $124.41 | 1356397210 - M SHEIKH | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 94453 | $99.73 | 1962664789 - JAMIE EVANS | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | MT | Psychiatry Physician (2084P0800X) |
United | 94453 | $36.93 | 1366890857 - STEVEN SHARP | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 94453 | $57.15 | 1568705622 - IUNIA DADARLAT | 352030653 - ARNETT CLINIC LLC | IL | Psychiatry Physician (2084P0800X) |
United | 94453 | $39.04 | 1700131182 - MATTHEW ATIENZA | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 94453 | $36.93 | 1174859284 - MATTHEW NIEDZWIECKI | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | CA | 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 94453 vs. Other Pulmonary Procedures Codes
The CPT 94453 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 94453 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 |
|---|---|---|
| 94450-CPT | Low | Breathing Response To Hypoxia |
| 94452-CPT | Low | High Altitude Simulation Test (Hast) With Interpretation And Report By A Physician Or Other Qualified Health Care Professional (Revised 01/01/13) |
| 94453-CPT | Low | High Altitude Simulation Test (Hast) With Interpretation And Report By A Physician Or Other Qualified Health Care Professional; With Supplemental Oxygen Titration (Revised 01/01/13) |
| 94667-CPT | Low | Manipulation Chest Wall, Such As Cupping, Percussing, And Vibration To Facilitate Lung Function; Initial Demonstration And/Or Evaluation |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 94453. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 94453 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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