How much does Medicare pay for CPT 00402?

Medicare allowed an average of $220.85 per service and paid $172.57 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $2429.38, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 00402?

Anesthesia for reconstruction of breast. It was billed 1,170 times to 1,139 Medicare beneficiaries by 77 providers in 2024.

Does 00402 pay differently in an office than a hospital?

Yes. The allowed amount averaged $169.69 in an office setting and $228.96 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 00402 most?

Anesthesiology, with 717 services from 47 clinicians. Next are Certified Registered Nurse Anesthetist (CRNA), Pain Management.

CPT 00402

Anesthesia for reconstruction of breast

$220.85Medicare-allowed amount per service, averaged across 1,170 services

Providers submitted

$2429.38

Asking price, not received

Medicare allowed

$220.85

The fee schedule figure

Medicare paid

$172.57

Balance is patient coinsurance

Providers submitted an average of $2429.38 for this code and Medicare allowed $220.85 — 11.0× 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 $172.57 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $169.69
Hospital / facility: $228.96

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 160 services were billed in an office setting and 1,010 in a facility.

Services: 1,170
Beneficiaries: 1,139
Providers billing it: 77
Total allowed: $258,395

What Medicare pays for CPT 00402

Across 1,170 services billed by 77 providers to 1,139 beneficiaries, Medicare allowed an average of $220.85 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 00402

Specialty	Services	Beneficiaries	Avg allowed	Providers
Anesthesiology	717	700	$200.63	47
Certified Registered Nurse Anesthetist (CRNA)	439	425	$255.55	29
Pain Management	14	14	$168.25	1

00402 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
New York	228	$179.06	$124.77	15
Florida	146	$229.50	$170.63	11
Texas	125	$232.90	$181.23	9
California	78	$264.14	$205.75	6
Mississippi	75	$161.37	$131.35	5
Louisiana	71	$423.48	$343.14	5
Maryland	70	$268.58	$201.43	3
Massachusetts	50	$175.29	$122.72	4
Kansas	42	$182.37	$146.89	3
Arizona	38	$246.97	$194.38	2
Illinois	37	$197.51	$139.74	2
Washington	34	$269.82	$205.49	1
Pennsylvania	31	$159.80	$117.24	1
Tennessee	25	$130.68	$99.17	2
Virginia	20	$156.67	$116.57	1
Georgia	20	$116.52	$78.30	1
Nevada	19	$272.67	$219.83	1
North Carolina	14	$168.61	$131.57	1
Kentucky	13	$182.82	$146.52	1
Missouri	12	$297.27	$228.87	1
Minnesota	11	$220.12	$177.27	1
South Dakota	11	$135.78	$112.64	1

Related codes

00400Anesthesia for other procedure on skin of arms$98.17
0042TComputed tomography (ct) of brain blood flow$212.67
00410Anesthesia for procedure to correct abnormal heart rhythm$72.03

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.