How much does Medicare pay for CPT 00813?

Medicare allowed an average of $125.41 per service and paid $96.52 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1323.82, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 00813?

Anesthesia for procedure on small and large bowel using an endoscope. It was billed 402,551 times to 402,093 Medicare beneficiaries by 15,783 providers in 2024.

Does 00813 pay differently in an office than a hospital?

Yes. The allowed amount averaged $137.22 in an office setting and $124.95 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 00813 most?

Certified Registered Nurse Anesthetist (CRNA), with 218,632 services from 8,313 clinicians. Next are Anesthesiology, Anesthesiology Assistant, Pain Management.

CPT 00813

Anesthesia for procedure on small and large bowel using an endoscope

$125.41Medicare-allowed amount per service, averaged across 402,551 services

Providers submitted

$1323.82

Asking price, not received

Medicare allowed

$125.41

The fee schedule figure

Medicare paid

$96.52

Balance is patient coinsurance

Providers submitted an average of $1323.82 for this code and Medicare allowed $125.41 — 10.6× 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 $96.52 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $137.22
Hospital / facility: $124.95

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. 15,275 services were billed in an office setting and 387,276 in a facility.

Services: 402,551
Beneficiaries: 402,093
Providers billing it: 15,783
Total allowed: $50,483,921

What Medicare pays for CPT 00813

Across 402,551 services billed by 15,783 providers to 402,093 beneficiaries, Medicare allowed an average of $125.41 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 00813

Specialty	Services	Beneficiaries	Avg allowed	Providers
Certified Registered Nurse Anesthetist (CRNA)	218,632	218,400	$131.83	8,313
Anesthesiology	176,160	175,944	$118.98	7,132
Anesthesiology Assistant	4,984	4,978	$79.16	236
Pain Management	933	931	$114.15	42
Interventional Pain Management	746	745	$103.87	19
Critical Care (Intensivists)	395	395	$89.64	17
Internal Medicine	312	311	$139.80	11
Hospice and Palliative Care	77	77	$164.66	1
Emergency Medicine	64	64	$117.71	2
General Practice	62	62	$107.04	2
Physical Medicine and Rehabilitation	55	55	$74.46	1
Sleep Medicine	35	35	$112.39	1
Hospitalist	28	28	$105.81	2
Osteopathic Manipulative Medicine	25	25	$108.52	1
Addiction Medicine	18	18	$161.98	1

00813 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	41,509	$126.57	$94.60	1,376
Texas	34,736	$120.39	$92.47	1,213
California	31,382	$159.25	$119.11	1,238
New York	26,175	$142.47	$100.71	976
Pennsylvania	21,657	$109.52	$82.64	846
Illinois	19,481	$130.85	$96.64	822
New Jersey	13,559	$126.99	$91.75	512
Virginia	13,441	$108.50	$82.80	561
North Carolina	13,318	$115.13	$89.51	544
Maryland	12,779	$139.90	$103.66	389
Massachusetts	12,322	$108.40	$80.65	588
Ohio	11,784	$119.46	$92.73	511
Tennessee	10,870	$121.95	$96.62	389
South Carolina	10,672	$110.77	$86.73	384
Georgia	10,210	$113.77	$87.26	413
Michigan	9,331	$102.71	$75.86	445
Missouri	7,726	$118.14	$91.24	348
Kentucky	7,517	$125.63	$99.09	304
Arizona	7,305	$132.03	$102.84	288
Alabama	7,229	$95.40	$76.94	290
Connecticut	7,031	$112.48	$82.56	293
Indiana	5,929	$120.67	$95.02	285
Kansas	5,091	$125.56	$99.32	237
Louisiana	5,065	$126.91	$100.34	184
Oklahoma	5,042	$139.48	$110.35	193
Mississippi	4,871	$118.37	$93.72	145
Wisconsin	4,144	$113.18	$89.03	201
Washington	3,645	$149.68	$112.86	180
Colorado	3,271	$136.44	$105.33	151
Minnesota	3,268	$102.45	$79.78	151
Arkansas	3,152	$138.41	$113.95	105
Nevada	2,649	$137.66	$108.56	82
Delaware	2,641	$117.23	$88.75	77
South Dakota	2,331	$103.12	$81.36	104
West Virginia	2,193	$108.42	$82.53	106
Nebraska	2,005	$129.37	$101.88	81
New Hampshire	1,668	$128.85	$97.33	95
Iowa	1,653	$131.49	$103.38	77
District of Columbia	1,552	$114.81	$84.07	67
Rhode Island	1,452	$112.54	$84.32	60
New Mexico	1,346	$151.18	$117.28	50
Oregon	1,322	$143.04	$109.22	67
Utah	1,310	$132.41	$101.41	63
Maine	982	$115.03	$85.82	54
North Dakota	951	$111.54	$86.64	41
Hawaii	922	$148.02	$113.35	38
Wyoming	894	$145.47	$110.86	28
Puerto Rico	757	$151.57	$111.45	11
Montana	705	$156.73	$119.19	43
Idaho	682	$140.67	$114.72	30
Alaska	429	$199.06	$123.51	22
Vermont	398	$116.46	$90.77	20
AE	113	$124.09	$90.07	2
ZZ	36	$144.63	$115.65	1
U.S. Virgin Islands	27	$182.32	$134.68	1
Guam	21	$165.70	$132.56	1

Related codes

00811Anesthesia for other procedure on large bowel$99.16
00812Anesthesia for exam of colon$82.06
00840Anesthesia for other procedure on lower abdomen$197.81
00873Anesthesia for shock wave therapy for urinary system stones without wa$129.00
00830Anesthesia for other repair of lower abdomen hernia (1 year or older)$137.91
00865Anesthesia for extensive removal of prostate$273.52
00860Anesthesia for other procedure on lower abdomen outside abdominal cavi$170.50
00862Anesthesia for procedure on upper urinary tubes or removal of kidney f$283.02
00880Anesthesia for other procedure on large blood vessel of lower abdomen$445.90

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.