Medicare reimbursement reference

CPT 94452: $60

Medicine / E&M. The federally-set baseline for what this code costs when Medicare pays — used by every bill-review professional as the starting point when reviewing the same code on a hospital, ER, or clinic bill.

Data updated today·Source: CMS Physician Fee Schedule

National average

$60

Per CMS Physician Fee Schedule, effective 2026-01-01. Non-facility national-average. Real Medicare payments adjust by ±15% based on Geographic Practice Cost Index.

Rates by modifier

  • Global rate$60
  • Modifier TC — Technical component (the procedure itself)$45
  • Modifier 26 — Professional component (interpretation only)$15

Modifiers split a procedure’s payment between the technical (equipment / facility) and professional (interpretation / clinician) components, or signal special circumstances. The modifier on your bill should match what was actually performed.

What CPT 94452 actually is

Medical service or evaluation-and-management code (CPT 94452). E&M codes describe office, ER, hospital, and consult visits — chosen by the complexity and time of the encounter.

The number above is one piece of context. The other two benchmarks worth knowing:

  • Hospital cash-pay rate

    Federally required to be published by every US hospital under 45 CFR §180.50 (the Hospital Price Transparency rule). The hospital’s own machine-readable file is the authoritative source. Same code; rates vary widely by facility.

  • Insurance-negotiated rate

    Whatever your specific insurance plan and the specific facility have contracted for the same code. Visible on your Explanation of Benefits (EOB) after the claim posts.

  • Medicare allowed amount (this page)

    $60 for code 94452, set in federal law and updated annually by CMS. Used as the floor benchmark in most bill-review work.

Where CPT 94452 commonly shows up on a bill

Patterns bill-review professionals look at first when they see this code:

  • 01.A code billed at the global rate when only a partial component was rendered (modifier -26 or -TC may apply).
  • 02.The same code billed multiple times for what appears to be the same encounter.
  • 03.An item billed without supporting documentation in the medical record.

These patterns are documented in CMS billing guidance, the National Correct Coding Initiative (NCCI) edits, and Office of Inspector General audit reports. None of them are accusations about any specific bill or facility — they’re the checks that exist because the patterns themselves exist.

If your bill has this code

See exactly how your charge compares to $60— in 60 seconds.

Upload a photo or PDF of your bill. Our system reads every line, compares each charge to four federal data sources (CMS PFS, NADAC drug benchmarks, federally-required Hospital Price Transparency files, and the National Correct Coding Initiative), and drafts dispute letters for anything worth questioning — with the codes, the math, and the federal-law citations already inside.

  • ✓Line-by-line audit, every charge benchmarked.
  • ✓Up to 5 dispute letters drafted — sign and mail.
  • ✓Charity-care application if your hospital is non-profit.
  • ✓We Found Something or You Don’t Pay.
Analyze my bill — $19.9730-day money-back. No account needed to start.

Related codes

Codes in the same numerical neighborhood — often appear together on the same bill or get billed in place of each other:

Common questions about CPT 94452

How much does CPT 94452 cost?
Medicare's national-average non-facility allowed amount for CPT 94452 is approximately $60 as of 2026-01-01. Hospital cash-pay rates and commercial-insurance contracted rates for the same code are typically higher; the gap is what most billing reviews focus on.
Why is my CPT 94452 bill higher than $60?
Three common reasons: (1) the rate above is non-facility — bills from inpatient hospital settings can be paid differently, (2) commercial insurance contracts and hospital chargemasters are not bound by Medicare rates and often run several multiples higher, and (3) modifiers on the bill may add or subtract from the base rate. The federally-mandated Hospital Price Transparency file for the facility that billed you is the authoritative source for the cash-pay and insurance-negotiated rates at that specific hospital.
Can I dispute a CPT 94452 charge?
Yes. Federal and state consumer-protection law gives every patient the right to (1) request an itemized statement (HIPAA §164.524), (2) receive a Good Faith Estimate before scheduled service (No Surprises Act, 2022), (3) dispute amounts billed without prior consent or proper notice, and (4) apply for charity care if the facility is a 501(c)(3) non-profit (ACA §501(r)). The benchmark above is one piece of evidence; the hospital's own HPT file is another.
What's the source of this number?
The CMS Physician Fee Schedule (PFS) — published annually by the Centers for Medicare & Medicaid Services and required by 42 USC §1395w-4 to be publicly available. We refresh from CMS quarterly. Last updated: 2026-01-01.

P.S.If you’re holding a bill with code 94452on it right now, the fastest path is to scan it — the audit takes under a minute and shows the exact gap between what was charged and the $60 benchmark above. Start the audit →

P.P.S. If the bill came from a non-profit hospital, federal law (ACA §501(r)) requires them to offer charity care to patients below specific income thresholds. We auto-check 501(c)(3) status against the IRS Publication 78 database and draft the application letter when applicable.

P.P.P.S. The $60number above is a benchmark, not a verdict. The right question on any specific bill is whether the documentation in your medical record supports the code that was billed — that’s what every bill-review process ultimately comes down to.

Source & methodology

Rate from the CMS Physician Fee Schedule, refreshed quarterly from cms.gov. National-average non-facility allowed amount; real Medicare payment adjusts by ±15% per locality (GPCI). The CMS PFS is in the public domain (17 USC §105). Full data-source register at /data-sources.