How much does Medicare pay for CPT 00103?

Medicare allowed an average of $139.67 per service and paid $108.80 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1237.09, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 00103?

Anesthesia for procedure on eyelid. It was billed 63,990 times to 63,015 Medicare beneficiaries by 2,219 providers in 2024.

Does 00103 pay differently in an office than a hospital?

Yes. The allowed amount averaged $109.42 in an office setting and $140.34 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 00103 most?

Certified Registered Nurse Anesthetist (CRNA), with 35,998 services from 1,204 clinicians. Next are Anesthesiology, Anesthesiology Assistant, Pain Management.

CPT 00103

Anesthesia for procedure on eyelid

$139.67Medicare-allowed amount per service, averaged across 63,990 services

Providers submitted

$1237.09

Asking price, not received

Medicare allowed

$139.67

The fee schedule figure

Medicare paid

$108.80

Balance is patient coinsurance

Providers submitted an average of $1237.09 for this code and Medicare allowed $139.67 — 8.9× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $108.80 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $109.42
Hospital / facility: $140.34

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 1,393 services were billed in an office setting and 62,597 in a facility.

Services: 63,990
Beneficiaries: 63,015
Providers billing it: 2,219
Total allowed: $8,937,483

What Medicare pays for CPT 00103

Across 63,990 services billed by 2,219 providers to 63,015 beneficiaries, Medicare allowed an average of $139.67 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 00103

Specialty	Services	Beneficiaries	Avg allowed	Providers
Certified Registered Nurse Anesthetist (CRNA)	35,998	35,390	$144.96	1,204
Anesthesiology	26,828	26,472	$134.45	959
Anesthesiology Assistant	892	883	$85.41	46
Pain Management	154	153	$127.43	6
Interventional Pain Management	71	70	$152.94	1
Critical Care (Intensivists)	34	34	$95.81	2
Vascular Surgery	13	13	$168.14	1

00103 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	5,860	$140.38	$105.44	171
California	5,247	$167.23	$127.15	201
Texas	4,142	$128.68	$100.94	141
New York	2,980	$140.50	$105.15	91
Pennsylvania	2,954	$117.72	$92.89	111
Georgia	2,859	$112.18	$88.67	109
Tennessee	2,514	$133.87	$110.23	94
Ohio	2,345	$135.44	$105.55	91
North Carolina	2,202	$124.38	$99.28	79
Arizona	2,156	$174.14	$138.97	64
Michigan	2,092	$124.89	$96.61	76
Virginia	2,037	$123.81	$97.76	60
South Carolina	1,981	$133.75	$108.68	53
Oklahoma	1,665	$162.53	$128.58	45
Missouri	1,458	$151.22	$120.10	56
Alabama	1,287	$85.30	$70.42	48
Washington	1,257	$170.48	$131.70	44
Massachusetts	1,173	$143.18	$109.93	55
Arkansas	1,144	$145.27	$121.04	23
Indiana	1,120	$119.03	$96.45	43
Illinois	1,105	$136.14	$103.82	43
Minnesota	1,102	$129.54	$102.15	39
Colorado	983	$133.98	$103.56	41
Kansas	960	$140.61	$112.41	33
Kentucky	910	$135.71	$108.48	44
South Dakota	876	$141.02	$116.13	12
New Jersey	855	$144.07	$105.07	32
Maryland	839	$161.98	$122.29	37
Mississippi	828	$150.72	$122.89	25
Louisiana	727	$155.48	$124.41	18
Iowa	599	$157.79	$125.80	13
Oregon	543	$138.54	$104.55	21
Utah	509	$152.49	$124.30	23
Connecticut	477	$96.27	$72.42	23
Nevada	465	$147.80	$118.04	13
Nebraska	441	$168.63	$141.90	15
Wisconsin	435	$124.28	$99.53	26
Delaware	404	$165.62	$133.16	10
Idaho	334	$164.14	$135.19	16
New Hampshire	296	$145.20	$118.06	13
North Dakota	287	$150.13	$124.76	6
Maine	283	$169.70	$132.74	10
West Virginia	257	$146.00	$115.23	16
Hawaii	250	$196.36	$156.71	5
Montana	166	$161.78	$123.51	6
Vermont	146	$129.28	$106.63	5
New Mexico	96	$145.16	$111.59	5
Rhode Island	88	$134.02	$101.01	4
District of Columbia	80	$95.95	$73.64	3
Alaska	68	$219.61	$123.20	2
Puerto Rico	66	$213.93	$167.87	3
Wyoming	22	$182.76	$145.85	1
Guam	20	$182.70	$137.93	1

Related codes

00142Anesthesia for lens surgery$94.99
00140Anesthesia for other procedure on eye$123.68
00145Anesthesia for retinal surgery$148.90
00104Anesthesia for electroshock therapy$80.75
00160Anesthesia for other procedure on nose and sinuses$150.31
00144Anesthesia for procedure on eye for corneal transplant$143.81
00170Anesthesia for other procedure on mouth$148.06
00120Anesthesia for other procedure on external middle and inner ear$184.90

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.