How much does Medicare pay for CPT 00865?

Medicare allowed an average of $273.52 per service and paid $216.34 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $3165.01, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 00865?

Anesthesia for extensive removal of prostate. It was billed 2,407 times to 2,407 Medicare beneficiaries by 142 providers in 2024.

Does 00865 pay differently in an office than a hospital?

Yes. The allowed amount averaged $333.47 in an office setting and $270.57 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 00865 most?

Anesthesiology, with 1,564 services from 90 clinicians. Next are Certified Registered Nurse Anesthetist (CRNA), Pain Management, Anesthesiology Assistant.

CPT 00865

Anesthesia for extensive removal of prostate

$273.52Medicare-allowed amount per service, averaged across 2,407 services

Providers submitted

$3165.01

Asking price, not received

Medicare allowed

$273.52

The fee schedule figure

Medicare paid

$216.34

Balance is patient coinsurance

Providers submitted an average of $3165.01 for this code and Medicare allowed $273.52 — 11.6× 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 $216.34 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $333.47
Hospital / facility: $270.57

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. 113 services were billed in an office setting and 2,294 in a facility.

Services: 2,407
Beneficiaries: 2,407
Providers billing it: 142
Total allowed: $658,363

What Medicare pays for CPT 00865

Across 2,407 services billed by 142 providers to 2,407 beneficiaries, Medicare allowed an average of $273.52 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 00865

Specialty	Services	Beneficiaries	Avg allowed	Providers
Anesthesiology	1,564	1,564	$286.50	90
Certified Registered Nurse Anesthetist (CRNA)	691	691	$261.49	43
Pain Management	81	81	$211.18	4
Anesthesiology Assistant	71	71	$175.86	5

00865 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
New York	406	$366.77	$258.96	21
Texas	394	$253.76	$198.86	21
Florida	350	$164.42	$129.42	20
California	197	$431.35	$321.05	14
Minnesota	122	$246.10	$188.04	9
Pennsylvania	114	$256.39	$194.69	6
Ohio	97	$212.06	$168.22	6
Maryland	91	$239.19	$181.72	6
Illinois	79	$262.03	$189.48	6
North Carolina	71	$196.26	$160.50	4
District of Columbia	64	$245.53	$176.53	1
Virginia	53	$244.07	$190.73	4
Georgia	50	$170.35	$135.69	2
Massachusetts	47	$270.26	$202.93	4
Iowa	44	$334.11	$273.14	1
New Jersey	42	$346.44	$248.54	3
Tennessee	28	$194.22	$162.19	2
Arkansas	25	$456.24	$379.01	1
Washington	24	$337.13	$260.54	2
Mississippi	14	$111.05	$101.39	1
Missouri	14	$168.84	$142.71	1
Colorado	12	$387.84	$302.93	1
Kansas	12	$218.59	$175.83	1
Indiana	12	$267.10	$191.08	1
Arizona	12	$496.04	$375.78	1
Delaware	11	$283.80	$200.39	1
Alabama	11	$98.20	$78.11	1
West Virginia	11	$192.77	$161.26	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
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.