CPT 94012
Global XXX ActiveSpirmtry w/brnchdil inf-2 yr
CPT 94012 Billing & Documentation Guide
CPT code 94012 (Spirmtry w/brnchdil inf-2 yr) is classified under Pulmonary with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.78, a non-facility practice expense RVU of 0.56, and a malpractice RVU of 0.17, a total non-facility RVU of 3.51 and facility RVU of 3.51. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $119.14, though rates vary from $111.85 to $162.33 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 94012, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 94012 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 94012 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 94012
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.78 | 2.78 |
| Practice Expense RVU | 0.56 | 0.56 |
| Malpractice RVU | 0.17 | 0.17 |
| Total RVU | 3.51 | 3.51 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 94012
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $121.39 | $121.39 | $117.98 - $133.08 | 29 |
| Florida | $122.68 | $122.68 | $119.27 - $126.69 | 3 |
| Georgia | $117.63 | $117.63 | $116.31 - $118.96 | 2 |
| Illinois | $122.11 | $122.11 | $118.81 - $125.33 | 4 |
| Michigan | $118.41 | $118.41 | $116.34 - $120.48 | 2 |
| North Carolina | $113.93 | $113.93 | $113.93 - $113.93 | 1 |
| New York | $125.84 | $125.84 | $114.62 - $131.58 | 5 |
| Ohio | $115.66 | $115.66 | $115.66 - $115.66 | 1 |
| Pennsylvania | $118.08 | $118.08 | $115.39 - $120.77 | 2 |
| Texas | $117.05 | $117.05 | $115.15 - $119.98 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 94012
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 94012 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0243T | Column 1 (primary), can be billed with modifier | No | HCPCS/CPT procedure code definition |
| 0244T | Column 1 (primary), can be billed with modifier | No | HCPCS/CPT procedure code definition |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36000 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36410 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 94010 | Column 1 (primary), can be billed with modifier | No | HCPCS/CPT procedure code definition |
| 94011 | Column 1 (primary), can be billed with modifier | No | HCPCS/CPT procedure code definition |
Frequently Asked Questions, CPT 94012
What does CPT code 94012 mean? +
CPT code 94012 represents: Spirmtry w/brnchdil inf-2 yr. It's in the Pulmonary category with a global period of XXX.
What is the Medicare reimbursement for CPT 94012? +
The 2026 Medicare national average non-facility payment for CPT 94012 is $119.14. Rates range from $111.85 to $162.33 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 94012? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 94012? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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