CPT 94452
Global XXX ActiveHast w/i&r phys/qhp
CPT 94452 Billing & Documentation Guide
CPT code 94452 (Hast w/i&r phys/qhp) is classified under Pulmonary with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.3, a non-facility practice expense RVU of 1.4, and a malpractice RVU of 0.02, a total non-facility RVU of 1.72 and facility RVU of 1.72. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $59.6, though rates vary from $50.53 to $78.91 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 94452, 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 94452 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 94452 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 94452
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.3 | 0.3 |
| Practice Expense RVU | 1.4 | 1.4 |
| Malpractice RVU | 0.02 | 0.02 |
| Total RVU | 1.72 | 1.72 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 94452
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 | $66.07 | $66.07 | $61.8 - $78.91 | 29 |
| Florida | $58.24 | $58.24 | $55.73 - $60.39 | 3 |
| Georgia | $55.45 | $55.45 | $52.53 - $58.36 | 2 |
| Illinois | $56.52 | $56.52 | $53.76 - $59.3 | 4 |
| Michigan | $54.87 | $54.87 | $53.47 - $56.27 | 2 |
| North Carolina | $54.08 | $54.08 | $54.08 - $54.08 | 1 |
| New York | $63.57 | $63.57 | $54.91 - $67.5 | 5 |
| Ohio | $53.39 | $53.39 | $53.39 - $53.39 | 1 |
| Pennsylvania | $56.63 | $56.63 | $53.58 - $59.68 | 2 |
| Texas | $56.73 | $56.73 | $53.19 - $60.11 | 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 94452
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 94452 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 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 |
| 94450 | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 94760 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 94761 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 96523 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 99201 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 99201 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 99202 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 99202 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 94452
What does CPT code 94452 mean? +
CPT code 94452 represents: Hast w/i&r phys/qhp. It's in the Pulmonary category with a global period of XXX.
What is the Medicare reimbursement for CPT 94452? +
The 2026 Medicare national average non-facility payment for CPT 94452 is $59.6. Rates range from $50.53 to $78.91 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 94452? +
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 94452? +
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 July 17, 2026.
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