How much does Medicare pay for HCPCS 0054T?

Medicare allowed an average of $168.86 per service and paid $134.61 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $686.10, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code 0054T?

Computer-assisted, fluoroscopic image-guided musculoskeletal surgical navigational orthopedic operation. It was billed 8,914 times to 8,640 Medicare beneficiaries by 206 providers in 2024.

Does 0054T pay differently in an office than a hospital?

Yes. The allowed amount averaged $164.01 in an office setting and $168.87 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 0054T most?

Orthopedic Surgery, with 8,440 services from 189 clinicians. Next are Physician Assistant, Sports Medicine, Nurse Practitioner.

HCPCS 0054T

Computer-assisted, fluoroscopic image-guided musculoskeletal surgical navigational orthopedic operation

$168.86Medicare-allowed amount per service, averaged across 8,914 services

Providers submitted

$686.10

Asking price, not received

Medicare allowed

$168.86

The fee schedule figure

Medicare paid

$134.61

Balance is patient coinsurance

Providers submitted an average of $686.10 for this code and Medicare allowed $168.86 — 4.1× 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 $134.61 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $164.01
Hospital / facility: $168.87

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 23 services were billed in an office setting and 8,891 in a facility.

Services: 8,914
Beneficiaries: 8,640
Providers billing it: 206
Total allowed: $1,505,218

What Medicare pays for HCPCS 0054T

Across 8,914 services billed by 206 providers to 8,640 beneficiaries, Medicare allowed an average of $168.86 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 0054T

Specialty	Services	Beneficiaries	Avg allowed	Providers
Orthopedic Surgery	8,440	8,176	$176.26	189
Physician Assistant	360	351	$25.12	13
Sports Medicine	52	52	$107.43	1
Nurse Practitioner	46	45	$26.39	2
General Surgery	16	16	$109.20	1

0054T 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	1,407	$226.07	$179.65	31
California	1,051	$93.31	$73.59	22
Texas	770	$223.87	$179.35	17
Colorado	767	$212.83	$168.57	16
Illinois	765	$166.72	$132.80	14
Virginia	532	$240.74	$193.63	7
North Carolina	459	$131.07	$102.38	11
South Carolina	326	$128.61	$101.58	4
Pennsylvania	248	$217.63	$169.52	7
Indiana	239	$123.82	$96.08	8
Idaho	223	$103.09	$82.09	4
Alabama	211	$125.84	$100.20	3
Arizona	208	$100.58	$79.80	4
Minnesota	185	$134.01	$108.26	7
New York	182	$168.64	$134.09	7
New Jersey	154	$236.68	$193.36	3
Wisconsin	121	$137.64	$112.81	6
Utah	101	$112.57	$87.36	3
Washington	95	$92.96	$76.20	3
Michigan	85	$125.89	$99.35	4
Iowa	85	$139.67	$111.98	3
Georgia	82	$115.84	$94.84	2
Nebraska	75	$75.24	$60.49	2
West Virginia	70	$157.10	$119.20	1
Kansas	66	$141.70	$114.41	5
Tennessee	66	$115.71	$91.84	2
Massachusetts	62	$167.76	$133.66	1
Montana	62	$100.39	$81.04	1
Arkansas	59	$196.86	$156.85	1
Missouri	54	$149.08	$118.64	3
Oregon	35	$104.86	$82.76	1
Hawaii	29	$104.79	$82.99	1
New Hampshire	21	$157.71	$125.66	1
Ohio	19	$46.91	$37.38	1

Related codes

00537Anesthesia for procedure to assess heart electrical activity$288.91
00520Anesthesia for other closed procedure on chest$146.70
00560Anesthesia for procedure on heart and large blood vessels$396.34
00530Anesthesia for insertion of permanent heart pacemaker$150.20
0055TMusculoskeletal surgical navigational orthopedic operation$185.99
00567Anesthesia for heart artery bypass grafting on heart-lung machine$659.46
00562Anesthesia for procedure on heart and large blood vessels$749.69
00532Anesthesia for access to central vein$105.90
00534Anesthesia for insertion or replace of pacing heart defibrillator$204.12
00541Anesthesia for procedure on chest$495.59

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.