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See a sample rate comparisonCPT 94781 Fee Schedule
Last Verified: October 2026
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.
Cars Bd Tst Inft 12mo 30min, Car Seat Bed Testing For Airway Integrity For Infants Through 12 Months Of Age With Continual Clinical Staff Observation And Continuous Recording Of Pulse Oximetry Heart Rate And Respiratory Rate With Interpretation And Report Each Additional Full 30 Minutes List Separately In Addition To Code For Primary Procedure
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Pulmonary Procedures |
| Common Place of Service | 21 - Inpatient Hospital 11 - Office |
| Common Modifiers | SA 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | $22.05 national non-facility rate (2026) · View Medicare rates for 94781 |
| Medicaid Fee Schedule | $17.385 median of the 8 states in the free preview · View Medicaid rates for 94781 |
National average reimbursement for CPT 94781 by major payers:
$24.93
$26.32
$26.13
$41.15
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CPT 94781
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$50.73Published rateMary Fahrmeier
Loyola University Medical Center
$37.50Published rateKelly Rhodes
Riverside Health System
$32.84Published rateLauren Prest
$23.52Published rateKapil Aedma
Swope Health Services
$9.64Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 94781 vs. Other Pulmonary Procedures Codes
The CPT 94781 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 94781 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, Circadian Respiratory Pattern Recording (Pediatricpneumogram) 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) |
| 94780-CPT | Low | Cars Bd Tst Inft 12mo 60 Min, Car Seat Bed Testing For Airway Integrity For Infants Through 12 Months Of Age With Continual Clinical Staff Observation And Continuous Recording Of Pulse Oximetry Heart Rate And Respiratory Rate With Interpretation And Report 60 Minutes |
| 94781-CPT | Low | Cars Bd Tst Inft 12mo 30min, Car Seat Bed Testing For Airway Integrity For Infants Through 12 Months Of Age With Continual Clinical Staff Observation And Continuous Recording Of Pulse Oximetry Heart Rate And Respiratory Rate With Interpretation And Report Each Additional Full 30 Minutes List Separately In Addition To Code For Primary Procedure |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 94781. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 94781 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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