How much does Medicare pay for CPT 00860?

Medicare allowed an average of $170.50 per service and paid $134.33 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1944.13, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 00860?

Anesthesia for other procedure on lower abdomen outside abdominal cavity. It was billed 2,330 times to 2,209 Medicare beneficiaries by 146 providers in 2024.

Does 00860 pay differently in an office than a hospital?

Yes. The allowed amount averaged $130.28 in an office setting and $176.02 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 00860 most?

Anesthesiology, with 1,534 services from 102 clinicians. Next are Certified Registered Nurse Anesthetist (CRNA), Pain Management, Obstetrics & Gynecology.

CPT 00860

Anesthesia for other procedure on lower abdomen outside abdominal cavity

$170.50Medicare-allowed amount per service, averaged across 2,330 services

Providers submitted

$1944.13

Asking price, not received

Medicare allowed

$170.50

The fee schedule figure

Medicare paid

$134.33

Balance is patient coinsurance

Providers submitted an average of $1944.13 for this code and Medicare allowed $170.50 — 11.4× 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 $134.33 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $130.28
Hospital / facility: $176.02

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 281 services were billed in an office setting and 2,049 in a facility.

Services: 2,330
Beneficiaries: 2,209
Providers billing it: 146
Total allowed: $397,265

What Medicare pays for CPT 00860

Across 2,330 services billed by 146 providers to 2,209 beneficiaries, Medicare allowed an average of $170.50 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 00860

Specialty	Services	Beneficiaries	Avg allowed	Providers
Anesthesiology	1,534	1,470	$177.61	102
Certified Registered Nurse Anesthetist (CRNA)	706	664	$165.54	39
Pain Management	58	43	$98.29	3
Obstetrics & Gynecology	21	21	$54.67	1
Anesthesiology Assistant	11	11	$99.33	1

00860 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	405	$181.32	$141.62	25
New York	195	$137.23	$97.94	12
California	181	$195.83	$146.02	13
New Jersey	171	$173.20	$130.62	8
Arkansas	169	$135.75	$112.12	5
Florida	159	$170.81	$134.03	11
North Carolina	150	$140.82	$111.67	8
Pennsylvania	85	$162.39	$125.01	7
Georgia	81	$156.40	$127.72	5
Arizona	65	$215.93	$168.81	5
Minnesota	61	$189.64	$148.38	4
Nebraska	59	$152.71	$126.70	5
Mississippi	54	$149.54	$125.15	4
Ohio	51	$108.06	$87.59	4
Illinois	46	$188.00	$141.02	3
Alabama	45	$102.50	$86.25	3
Virginia	40	$228.72	$180.12	3
District of Columbia	33	$178.34	$130.51	2
Iowa	31	$175.47	$148.40	1
South Carolina	30	$105.42	$86.20	2
Colorado	28	$272.67	$217.31	2
Nevada	27	$297.79	$235.17	1
Maryland	25	$220.04	$170.31	2
Michigan	24	$253.89	$190.07	2
Tennessee	23	$169.43	$141.59	2
Wyoming	17	$246.84	$204.62	1
Indiana	14	$104.10	$86.92	1
Hawaii	13	$354.83	$280.20	1
Oklahoma	13	$130.83	$108.26	1
Louisiana	13	$143.97	$118.70	1
Massachusetts	11	$180.13	$132.41	1
Kansas	11	$202.45	$139.41	1

Related codes

00811Anesthesia for other procedure on large bowel$99.16
00812Anesthesia for exam of colon$82.06
00813Anesthesia for procedure on small and large bowel$125.41
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
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.