CPT 95012 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 • Allergy and Clinical Immunology Procedures |
| Common Place of Service | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
National average reimbursement for CPT 95012 by major payers:
$24.97
$24.48
$25.58
$37.19
| 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 95012 | ||||||
United | 95012 | $45.54 | 1386800662 - NICHOLAS HATZIS | 364187449 | IL | Psychiatry Physician (2084P0800X) |
United | 95012 | $54.90 | 1265753867 - ASIFA CHOUDHRY | 850703768 - (IL) CARLE WEST PHYSICIAN GROUP INC | IN | Psychiatry Physician (2084P0800X) |
United | 95012 | $34.25 | 1801849559 - CHARLES MARCUCCILLI | 911780120 - (IL) RUSH UNIVERSITY MEDICAL CENTER | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95012 | $37.83 | 1326579756 - TONY TU | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 95012 | $34.66 | 1639691090 - KELLY RHODES | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | IL | Psychiatry Physician (2084P0800X) |
United | 95012 | $37.93 | 1619123114 - MARGARET MICHELSON | 363738206 - NORTHSHORE UNIVERSITY HEALTHSYSTEM FACULTY PRACTICE ASSOCIATES | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95012 | $30.05 | 1487841540 - CEZARY DUDZINSKI | 363149833 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 95012 | $38.49 | 1689787426 - KAREN SEVERSON | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 95012 | $66.33 | 1275564197 - PAUL BERKOWITZ | 842494027 - BRIGHTSIDE MEDICAL | AZ | Psychiatry Physician (2084P0800X) |
United | 95012 | $37.83 | 1235440058 - CAROLYN DOYLE | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 95012 | $33.04 | 1194149104 - ADVENTIST HEALTH PARTNERS, INC, SALT CREEK THERAPY CENTER | 364138353 - (IL) ADVENTIST HEALTH PARTNERS INC. | IL | Psychiatry Physician (2084P0800X) |
United | 95012 | $34.02 | 1205831393 - PRITI SINGH | 461302245 - (IL) ASSOCIATES IN PEDIATRIC NEUROLOGY SC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95012 | $45.54 | 1447264932 - CYNTHIA STACK | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95012 | $38.49 | 1689787426 - KAREN SEVERSON | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | FL | Psychiatry Physician (2084P0800X) |
United | 95012 | $22.25 | 1295728186 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
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 95012 vs. Other Allergy and Clinical Immunology Procedures Codes
The CPT 95012 code is part of the Medicine Services and Procedures services used for Allergy and Clinical Immunology 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 95012 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 |
|---|---|---|
| 95004-CPT | Low | Percutaneous Tests (Scratch Puncture Prick) Withallergenic Extracts Immediate Type Reaction Including Test Interpretation And Report Specify Number Of Tests (Revised 01/01/13) |
| 95012-CPT | Low | Nitric Oxide Expired Gas Determination |
| 95070-CPT | Low | Inhalation Bronchial Challenge Testing (Not Including Necessary Pulmonary Function Tests) With Histamine Methacholine Or Similar Compounds (Desc Rvsd 1/1/21) |
| 95076-CPT | Low | Ingestion Challenge Test (Sequential And Incremental Ingestion Of Test Items Eg Food Drug Or Other Substance); Initial 120 Minutes Of Testing |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 95012. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95012 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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