CPT 94726 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 • 26 - Professional component • 59 - Distinct Procedural Service |
| Complexity Level | Low |
National average reimbursement for CPT 94726 by major payers:
$68.45
$70.53
$74.04
$99.36
| 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 94726 | ||||||
United | 94726 | $21.12 | 1730246067 - SENADA BAJMAKOVIC-KACILA | 911780160 | IL | Psychiatry Physician (2084P0800X) |
United | 94726 | $18.54 | 1588761142 - MONA LAL | 363149833 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 94726 | $20.60 | 1992961643 - CYNTHIA GORDON | 815174138 - (IL) ILLINOIS PROFESSIONALS HEALTH PROGR | IL | Psychiatry Physician (2084P0800X) |
United | 94726 | $24.36 | 1881918415 - TUSHAR ADVANI | 910844563 | MT | Psychiatry Physician (2084P0800X) |
United | 94726 | $80.73 | 1366890857 - STEVEN SHARP | 910844563 | IL | Psychiatry Physician (2084P0800X) |
United | 94726 | $101.91 | 1225211600 - JOHN MILLICHAP | 731310891 - WARREN CLINIC INC | NC | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 94726 | $119.91 | 1194049676 - TRACY BINIUS | 410991680 - FAIRVIEW HEALTH SERVICES | IL | Psychiatry Physician (2084P0800X) |
United | 94726 | $102.72 | 1083622955 - ALMA BICKNESE | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 94726 | $77.94 | 1447365440 - AYAME TAKAHASHI | 364143823 - SIU PHYSICIANS & SURGEONS INC | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 94726 | $28.77 | 1568752665 - ANDREW KNOX | 390884478 - BELLIN MEMORIAL HOSPITAL INC | WI | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 94726 | $22.75 | 1356723811 - VICTOR PATRON ROMERO | 911780074 | IL | Psychiatry Physician (2084P0800X) |
United | 94726 | $79.13 | 1962664789 - JAMIE EVANS | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | MT | Psychiatry Physician (2084P0800X) |
United | 94726 | $132.63 | 1295791812 - LEON EPSTEIN | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 94726 | $18.72 | 1851825392 - ALEXIA COPENHAVER | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 94726 | $89.23 | 1205831393 - PRITI SINGH | 461302245 - (IL) ASSOCIATES IN PEDIATRIC NEUROLOGY SC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
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 94726 vs. Other Pulmonary Procedures Codes
The CPT 94726 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 94726 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 |
|---|---|---|
| 94681-CPT | Low | Oxygn Uptke,Expir.Gas Analy;Co2/Oxy |
| 94690-CPT | Low | Collection And Analysis Of Exhaled Air For Evaluation Of Lung Function At Rest |
| 94726-CPT | Low | Plethysmography For Determination Of Lung Volumes And, When Performed, Airway Resistance |
| 94727-CPT | Low | Gas Dilution Or Washout For Determination Of Lung Volumes And, When Performed, Distribution Of Ventilation And Closing Volumes |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 94726. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 94726 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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