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See a sample rate comparisonCPT 94799 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Lung Service Or Procedure, A Service Or Procedure Related To Lung Function And Breathing Ability.
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Pulmonary Procedures |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service 26 - Professional component |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 94799 |
| Medicaid Fee Schedule | $21.935 median of the 4 states in the free preview · View Medicaid rates for 94799 |
National average reimbursement for CPT 94799 by major payers:
$1,341.01
$35.69
$109.73
$558.80
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CPT 94799
5 of 25 sample ratesHigher to lower in this preview
Prisma Health-Midlands, Prisma Health Baptist Parkridge Hospital
Prisma Health-Midlands
$940.46Published rateOverlake Hospital Medical Center Lab
Overlake Hospital Medical Center
$448.29Published rateRothman Orthopaedic Specialty Hospital, LLC, Bucks County Specialty Hospital, LLC
Rothman Orthopaedic Specialty Hospital LLC
$338.64Published rateLifespan Of Massachusetts
$202.22Published rateClhg-Winn, LLC, Winn Parish Medical Center
$175.46Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 94799 vs. Other Pulmonary Procedures Codes
The CPT 94799 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 94799 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 |
| 94799-CPT | High | Lung Service Or Procedure, A Service Or Procedure Related To Lung Function And Breathing Ability. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 94799. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 94799 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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