How much does Medicare pay for CPT 01938?

Medicare allowed an average of $85.34 per service and paid $66.70 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1329.68, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does 01938 pay differently in an office than a hospital?

Yes. The allowed amount averaged $99.51 in an office setting and $82.90 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 01938 most?

Certified Registered Nurse Anesthetist (CRNA), with 43,435 services from 932 clinicians. Next are Anesthesiology, Anesthesiology Assistant, Pain Management.

CPT 01938

Anesthesia for injection, drainage or aspiration procedures on spine or spinal cord of lower back accessed through skin using imaging guidance

$85.34Medicare-allowed amount per service, averaged across 77,885 services

Providers submitted

$1329.68

Asking price, not received

Medicare allowed

$85.34

The fee schedule figure

Medicare paid

$66.70

Balance is patient coinsurance

Providers submitted an average of $1329.68 for this code and Medicare allowed $85.34 — 15.6× 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 $66.70 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $99.51
Hospital / facility: $82.90

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. 11,472 services were billed in an office setting and 66,413 in a facility.

Services: 77,885
Beneficiaries: 65,986
Providers billing it: 1,750
Total allowed: $6,646,706

What Medicare pays for CPT 01938

Across 77,885 services billed by 1,750 providers to 65,986 beneficiaries, Medicare allowed an average of $85.34 per service. That is 1.2 services per beneficiary, so this is a code patients typically receive more than once. 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 01938

Specialty	Services	Beneficiaries	Avg allowed	Providers
Certified Registered Nurse Anesthetist (CRNA)	43,435	36,443	$86.88	932
Anesthesiology	33,151	28,359	$83.94	771
Anesthesiology Assistant	870	844	$51.45	36
Pain Management	299	246	$106.63	6
Interventional Pain Management	118	82	$105.00	4
Hospitalist	12	12	$109.24	1

01938 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	12,327	$74.13	$57.86	362
California	9,793	$107.32	$82.45	183
New York	6,826	$93.11	$65.98	144
Florida	6,038	$87.46	$66.56	140
Alabama	5,151	$59.91	$49.65	110
Pennsylvania	4,834	$63.16	$49.75	100
Georgia	4,612	$98.57	$75.97	80
Arizona	4,129	$93.75	$74.93	53
New Jersey	3,598	$86.36	$63.96	94
Michigan	2,634	$73.79	$56.94	52
Louisiana	2,424	$79.04	$63.21	65
Illinois	1,811	$87.12	$65.37	59
Kentucky	1,418	$89.26	$70.54	6
Maryland	1,282	$103.74	$76.34	25
Colorado	1,220	$101.93	$77.75	20
Nevada	814	$97.94	$78.94	21
Indiana	776	$73.18	$60.07	22
Virginia	714	$95.83	$71.35	14
Ohio	688	$63.57	$50.09	26
Connecticut	675	$69.04	$51.79	22
Massachusetts	644	$91.89	$70.53	20
Tennessee	632	$87.09	$68.26	18
North Carolina	566	$57.60	$45.56	8
Arkansas	400	$77.69	$65.19	7
Iowa	378	$99.12	$79.73	2
Mississippi	372	$90.68	$78.68	16
Oklahoma	348	$99.36	$79.93	9
Hawaii	295	$100.19	$77.61	3
Wisconsin	290	$77.91	$63.15	7
Washington	282	$106.81	$83.10	8
Minnesota	282	$92.16	$75.17	10
Missouri	244	$98.70	$76.32	3
Utah	167	$49.47	$41.17	1
Nebraska	145	$96.08	$78.56	5
Delaware	139	$83.35	$61.89	5
Rhode Island	134	$54.86	$43.08	4
District of Columbia	118	$102.33	$80.51	2
South Carolina	104	$86.54	$70.49	5
Maine	100	$98.07	$76.70	3
Kansas	86	$79.18	$65.73	3
New Hampshire	65	$65.63	$49.60	1
Idaho	64	$90.89	$76.17	3
West Virginia	60	$51.23	$39.34	2
Oregon	56	$100.44	$77.96	2
New Mexico	50	$91.80	$74.76	1
Vermont	38	$99.06	$78.15	1
Guam	24	$101.74	$76.80	1
U.S. Virgin Islands	23	$135.54	$108.01	1
Wyoming	15	$98.70	$79.81	1

Related codes

01922Anesthesia for x-ray or radiation therapy$135.98
01992Anesthesia for nerve block and injection procedure$117.33
01926Anesthesia for x-ray on artery of brain$227.98
01940Anesthesia for nerve destruction procedures on spine or spinal cord of$107.14
01996Daily hospital management of continuous spinal drug administration$62.53
01937Anesthesia for injection$89.46
01942Anesthesia for nerve modulation procedure spinal cord or repair of bon$152.21
01924Anesthesia for x-ray on arteries$214.93
01939Anesthesia for nerve destruction procedures on spine or spinal cord of$107.35
01916Anesthesia for x-ray exam of arteries and veins$162.11
01991Anesthesia for nerve block and injection$78.53
01920Anesthesia for x-ray on heart vessels and chambers$181.92

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.