CPT 94781 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 | • 21 - Inpatient Hospital • 11 - Office |
| Common Modifiers | • None • SA • 59 - Distinct Procedural Service |
| Complexity Level | Low |
National average reimbursement for CPT 94781 by major payers:
$24.93
$26.32
$26.13
$42.93
| 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 94781 | ||||||
United | 94781 | $25.34 | 1922481530 - THOMAS LOBUR | 362709982 - (IL) PRESENCE BEHAVIORAL HEALTH | IL | Psychiatry Physician (2084P0800X) |
United | 94781 | $24.12 | 1023112745 - NELDA AKINBILE | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | IL | Psychiatry Physician (2084P0800X) |
United | 94781 | $39.77 | 1225211600 - JOHN MILLICHAP | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | CO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 94781 | $31.62 | 1245252303 - MARY FAHRMEIER | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 94781 | $37.50 | 1235440058 - CAROLYN DOYLE | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | CA | Psychiatry Physician (2084P0800X) |
United | 94781 | $39.77 | 1801849559 - CHARLES MARCUCCILLI | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 94781 | $39.77 | 1811068554 - JAMES MACKENZIE | 205547757 - (IL) LURIE CHILDRENS MEDICAL GROUP LLC | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 94781 | $23.52 | 1083815435 - HUGO SOLARI | 320115907 - (IL) ESPERANZA HEALTH CENTERS | IL | Psychiatry Physician (2084P0800X) |
United | 94781 | $25.34 | 1972063501 - PALOMA REINOSO | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 94781 | $16.70 | 1881918415 - TUSHAR ADVANI | 910844563 | IL | Psychiatry Physician (2084P0800X) |
United | 94781 | $32.84 | 1639691090 - KELLY RHODES | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | IL | Psychiatry Physician (2084P0800X) |
United | 94781 | $49.45 | 1225211600 - JOHN MILLICHAP | 260899565 - MERCY SPECIALTY CLINIC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 94781 | $22.89 | 1437438249 - KAPIL AEDMA | 430957840 - SWOPE HEALTH SERVICES | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 94781 | $9.64 | 1437438249 - KAPIL AEDMA | 430957840 - SWOPE HEALTH SERVICES | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 94781 | $33.93 | 1477074060 - OLATOLA IYI-OJO | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 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 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) |
| 94781-CPT | Low | Car Seat/Bed Testing For Airway Integrity For Infants Through 12 Months Of Age With Continual Clinical Staff Observation And Continuous Record- Ing Of Pulse Oximetry Heart Rate And Respiratory Rate With Interpretation And Report; Each Addi- Tional Full 30 Minutes (List Separately In Addition To Code For Primary Procedure) (Desc Rvsd 1/1/19) |
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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 94781) and we'll show you how you compare in 15 minutes or less.