CPT 94775 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 |
| Common Modifiers | • None |
| Complexity Level | Low |
National average reimbursement for CPT 94775 by major payers:
$149.83
$63.56
$60.92
$98.65
| 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 94775 | ||||||
United | 94775 | $121.26 | 1386755486 - DOUGLAS NORDLI | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 94775 | $76.91 | 1275562779 - BARRY RABIN | 581672987 - (IL) EDWARD HEALTH VENTURES | IL | Psychiatry Physician (2084P0800X) |
United | 94775 | $90.72 | 1689787426 - KAREN SEVERSON | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | VA | Psychiatry Physician (2084P0800X) |
United | 94775 | $97.86 | 1760778468 - NATHAN ONTROP | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 94775 | $91.18 | 1679526784 - ELTON SMITH | 910844563 | PA | Psychiatry Physician (2084P0800X) |
United | 94775 | $97.86 | 1760461867 - RITA YADAVA | 363878197 - (IL) RITA YADAVA MDSC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 94775 | $57.66 | 1275564197 - PAUL BERKOWITZ | 842494027 - BRIGHTSIDE MEDICAL | IN | Psychiatry Physician (2084P0800X) |
United | 94775 | $89.16 | 1326465436 - MUSADDIQ TARIQ | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | MS | Psychiatry Physician (2084P0800X) |
United | 94775 | $60.25 | 1487018081 - OLUWEMIMO ADEYANJU | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 94775 | $97.86 | 1447372842 - GEOFFREY LEVIN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 94775 | $79.20 | 1770014920 - JOSEPH PEPITONE | 363738206 - NORTHSHORE UNIVERSITY HEALTHSYSTEM FACULTY PRACTICE ASSOCIATES | VT | Psychiatry Physician (2084P0800X) |
United | 94775 | $107.55 | 1255696290 - COURTNEY ROMBA | 364187449 | IL | Psychiatry Physician (2084P0800X) |
United | 94775 | $91.18 | 1760412621 - RHONDA LAMPEN | 910844563 | IL | Psychiatry Physician (2084P0800X) |
United | 94775 | $83.18 | 1982268959 - SIDRAH NAJAM | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IN | Psychiatry Physician (2084P0800X) |
United | 94775 | $75.22 | 1881918415 - TUSHAR ADVANI | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | 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 94775 vs. Other Pulmonary Procedures Codes
The CPT 94775 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 94775 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 |
|---|---|---|
| 94772-CPT | Moderate | Circadian Respiratory Pattern Recording (Pediatric Pneumogram), 12 To 24 Hour Continuous Recording, Infant |
| 94774-CPT | Moderate | Pediatric Home Apnea Monitoring Event Recording Including Respiratory Rate Pattern And Heart Rate Per 30-Day Period Of Time; Includes Monitor Attachment Download Of Data Review Interpretation And Preparation Of A Report By A Physician Or Other Qualified Health Care Professional (Revised 01/01/13) |
| 94775-CPT | Low | Pediatric Home Apnea Monitoring Event Recording Including Respiratory Rate, Pattern And Heart Rate Per 30-Day Period Of Time; Monitor Attachment Only (Includes Hook-Up, Initiation Of Recording And Disconnection) |
| 94776-CPT | Moderate | Pediatric Home Apnea Monitoring Event Recording Including Respiratory Rate, Pattern And Heart Rate Per 30-Day Period Of Time; Monitoring, Download Of Information, Receipt Of Transmission(S) And Analyses By Computer Only |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 94775. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 94775 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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