Summary & Overview
CPT 94012: Pediatric Forced Expiratory Flow with Bronchodilation
CPT code 94012 represents a pediatric pulmonary function test that measures forced expiratory flow after bronchodilation in infants and children up to age 2. This specialized diagnostic procedure evaluates airway function, identifies lung dysfunction and disease, and assesses response to therapeutic interventions. As a narrowly targeted pediatric test, it matters nationally for ensuring appropriate diagnosis and management of early-life respiratory disorders, for informing quality measures in pediatric pulmonology, and for aligning coverage policies across major payers.
Key payers addressed in this publication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, an outline of typical sites of care, and a summary of common billing considerations tied to pediatric pulmonary function testing. The report identifies typical modifiers used in billing (where provided), specifies that clinical use is for infants and toddlers up to age 2, and notes where input data are not available.
This publication equips clinicians, billing staff, and policy analysts with clear, actionable information on what CPT code 94012 represents, how it is used clinically, and which national payers are commonly involved in coverage and reimbursement discussions. Data not available in the input are explicitly noted where applicable.
Billing Code Overview
CPT code 94012 describes a pulmonary function test for infants and young children up to age 2 that measures forced expiratory flow following bronchodilation. The procedure assesses airway function by having the provider elicit a forced exhalation to evaluate lung dysfunction, respiratory disease, and the effects of therapeutic interventions.
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Service type: Pediatric pulmonary function testing with bronchodilator challenge
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Typical site of service: Outpatient pediatric pulmonary laboratory or hospital outpatient department
Clinical & Coding Specifications
Clinical Context
A 14-month-old male with recurrent wheeze and suspected reactive airways disease is referred to pediatric pulmonary function testing. During the clinic visit, a pediatric pulmonologist evaluates the infant, documents respiratory symptoms, prior hospitalizations for bronchiolitis, current medications (inhaled albuterol), and vital signs. Indications for testing include assessment of airway obstruction and response to bronchodilator therapy.
The clinical workflow includes: pre-test screening for acute illness; explanation to the parent of the test sequence; measurement of baseline infant pulmonary mechanics using specialized infant pulmonary function testing equipment; administration of a standardized bronchodilator (nebulized albuterol) per protocol; repeat measurement of forced expiratory flows after bronchodilation to assess reversibility. A respiratory therapist or pulmonary function technologist performs the maneuver with support from the provider. Results are interpreted by the pediatric pulmonologist and documented in the medical record with correlation to clinical findings and management decisions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the physician interpretation/report is billed separate from technical services. |