How much does Medicare pay for HCPCS 0042T?

Medicare allowed an average of $212.67 per service and paid $167.88 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $687.65, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code 0042T?

Computed tomography (ct) of brain blood flow, volume, and timing of flow analysis with contrast. It was billed 37,325 times to 37,053 Medicare beneficiaries by 1,409 providers in 2024.

Which specialty bills 0042T most?

Diagnostic Radiology, with 35,047 services from 1,343 clinicians. Next are Interventional Radiology, Nuclear Medicine, Neurology.

HCPCS 0042T

Computed tomography (ct) of brain blood flow, volume, and timing of flow analysis with contrast

$212.67Medicare-allowed amount per service, averaged across 37,325 services

Providers submitted

$687.65

Asking price, not received

Medicare allowed

$212.67

The fee schedule figure

Medicare paid

$167.88

Balance is patient coinsurance

Providers submitted an average of $687.65 for this code and Medicare allowed $212.67 — 3.2× 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 $167.88 (79%); the rest is the patient’s coinsurance and deductible.

Services: 37,325
Beneficiaries: 37,053
Providers billing it: 1,409
Total allowed: $7,937,908

What Medicare pays for HCPCS 0042T

Across 37,325 services billed by 1,409 providers to 37,053 beneficiaries, Medicare allowed an average of $212.67 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 0042T

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	35,047	34,792	$212.90	1,343
Interventional Radiology	2,150	2,133	$209.98	61
Nuclear Medicine	114	114	$209.65	4
Neurology	14	14	$93.62	1

0042T 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	8,090	$218.02	$169.51	294
Texas	5,107	$213.11	$167.39	154
Pennsylvania	3,373	$217.74	$169.40	133
New Jersey	3,038	$245.79	$193.79	93
Colorado	1,652	$228.82	$175.97	59
Maryland	1,503	$227.14	$177.58	55
Virginia	1,447	$218.64	$174.85	60
New York	1,229	$183.50	$143.62	54
California	1,145	$150.07	$118.01	59
Mississippi	912	$200.71	$159.62	23
Georgia	891	$204.52	$160.93	49
Louisiana	809	$202.11	$157.74	37
District of Columbia	773	$247.99	$197.59	16
North Carolina	773	$211.71	$166.63	21
Tennessee	646	$196.26	$155.85	32
Minnesota	570	$206.39	$162.95	27
Delaware	450	$155.56	$123.94	13
Arizona	433	$188.40	$149.90	9
Michigan	424	$184.72	$147.10	25
Illinois	414	$188.20	$146.41	16
Arkansas	331	$203.94	$160.34	14
Missouri	311	$243.77	$190.92	15
Alabama	303	$136.43	$106.91	19
Iowa	273	$281.38	$223.90	8
Ohio	256	$215.24	$171.44	7
Connecticut	245	$223.68	$175.85	9
Oklahoma	214	$193.58	$136.99	15
Massachusetts	205	$207.21	$164.04	11
Washington	203	$138.04	$107.62	11
New Mexico	137	$216.37	$161.60	7
Indiana	135	$210.04	$162.01	5
South Carolina	122	$216.39	$167.64	8
Kentucky	105	$224.97	$175.58	4
Hawaii	99	$93.51	$69.01	5
Wisconsin	93	$233.83	$177.35	3
Nevada	89	$113.62	$89.57	5
New Hampshire	85	$216.40	$167.53	5
West Virginia	83	$207.95	$164.28	6
Idaho	75	$129.05	$99.15	5
Alaska	52	$221.54	$176.51	4
AA	42	$214.43	$170.85	1
Kansas	36	$283.96	$226.24	3
Rhode Island	29	$228.53	$175.71	2
Maine	27	$213.64	$163.87	2
South Dakota	24	$209.83	$167.18	1
Nebraska	18	$217.12	$170.84	1
Oregon	15	$62.10	$49.48	1
Montana	15	$64.75	$51.59	1
Puerto Rico	13	$215.55	$158.33	1
Wyoming	11	$64.26	$51.20	1

Related codes

00400Anesthesia for other procedure on skin of arms$98.17
00410Anesthesia for procedure to correct abnormal heart rhythm$72.03
00402Anesthesia for reconstruction of breast$220.85

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.