How much does Medicare pay for HCPCS 0055T?

Medicare allowed an average of $185.99 per service and paid $148.43 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $901.76, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code 0055T?

Musculoskeletal surgical navigational orthopedic operation using imaging guidance. It was billed 30,209 times to 28,916 Medicare beneficiaries by 596 providers in 2024.

Does 0055T pay differently in an office than a hospital?

Yes. The allowed amount averaged $224.96 in an office setting and $185.64 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 0055T most?

Orthopedic Surgery, with 28,605 services from 554 clinicians. Next are Physician Assistant, Sports Medicine, Osteopathic Manipulative Medicine.

HCPCS 0055T

Musculoskeletal surgical navigational orthopedic operation using imaging guidance

$185.99Medicare-allowed amount per service, averaged across 30,209 services

Providers submitted

$901.76

Asking price, not received

Medicare allowed

$185.99

The fee schedule figure

Medicare paid

$148.43

Balance is patient coinsurance

Providers submitted an average of $901.76 for this code and Medicare allowed $185.99 — 4.8× 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 $148.43 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $224.96
Hospital / facility: $185.64

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 269 services were billed in an office setting and 29,940 in a facility.

Services: 30,209
Beneficiaries: 28,916
Providers billing it: 596
Total allowed: $5,618,572

What Medicare pays for HCPCS 0055T

Across 30,209 services billed by 596 providers to 28,916 beneficiaries, Medicare allowed an average of $185.99 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 0055T

Specialty	Services	Beneficiaries	Avg allowed	Providers
Orthopedic Surgery	28,605	27,370	$191.91	554
Physician Assistant	832	813	$31.62	25
Sports Medicine	261	253	$159.07	6
Osteopathic Manipulative Medicine	202	190	$129.33	1
Nurse Practitioner	148	141	$29.75	5
Neurosurgery	124	112	$214.86	3
Hand Surgery	24	24	$157.71	1
General Surgery	13	13	$34.60	1

0055T 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
Texas	2,964	$221.33	$176.08	64
Pennsylvania	2,513	$204.35	$161.86	50
California	2,402	$198.28	$157.39	32
Florida	2,261	$242.53	$191.73	41
Illinois	1,826	$173.22	$135.71	31
Arizona	1,793	$193.67	$154.90	28
New York	1,695	$178.47	$141.79	30
Tennessee	1,394	$115.69	$92.01	28
North Carolina	1,296	$128.63	$100.50	21
Louisiana	1,243	$219.77	$174.18	21
Kansas	953	$185.30	$147.26	12
Oklahoma	916	$212.12	$168.93	8
Washington	753	$218.15	$175.00	22
South Carolina	746	$128.39	$100.10	9
Massachusetts	738	$157.66	$124.76	14
Missouri	601	$238.74	$190.06	15
Virginia	535	$140.67	$110.12	14
Arkansas	522	$164.38	$131.34	12
Georgia	522	$140.12	$109.82	12
Minnesota	491	$39.79	$32.38	18
Oregon	406	$206.74	$164.96	9
Michigan	376	$220.44	$174.75	11
New Jersey	371	$233.31	$187.50	11
Wisconsin	297	$95.27	$77.72	10
Idaho	296	$174.52	$139.63	7
New Mexico	268	$217.75	$172.56	7
Indiana	228	$78.21	$62.20	9
Iowa	228	$140.19	$110.87	7
Connecticut	218	$176.29	$139.24	6
Vermont	206	$148.92	$118.64	5
Utah	168	$196.97	$157.13	5
West Virginia	165	$145.31	$111.04	5
Mississippi	156	$207.25	$165.38	5
Rhode Island	132	$170.19	$134.64	2
Alabama	128	$126.24	$99.94	6
Colorado	128	$222.85	$177.30	3
New Hampshire	125	$89.55	$71.38	3
Delaware	102	$240.80	$191.86	1
North Dakota	33	$198.20	$162.19	1
Montana	14	$239.61	$190.91	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
00567Anesthesia for heart artery bypass grafting on heart-lung machine$659.46
00562Anesthesia for procedure on heart and large blood vessels$749.69
0054TComputer-assisted$168.86
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.