How much does Medicare pay for CPT 01996?

Medicare allowed an average of $62.53 per service and paid $49.18 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $405.07, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 01996?

Daily hospital management of continuous spinal drug administration. It was billed 16,904 times to 9,902 Medicare beneficiaries by 370 providers in 2024.

Which specialty bills 01996 most?

Anesthesiology, with 10,699 services from 278 clinicians. Next are Nurse Practitioner, Pain Management, Physician Assistant.

CPT 01996

Daily hospital management of continuous spinal drug administration

$62.53Medicare-allowed amount per service, averaged across 16,904 services

Providers submitted

$405.07

Asking price, not received

Medicare allowed

$62.53

The fee schedule figure

Medicare paid

$49.18

Balance is patient coinsurance

Providers submitted an average of $405.07 for this code and Medicare allowed $62.53 — 6.5× 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 $49.18 (79%); the rest is the patient’s coinsurance and deductible.

Services: 16,904
Beneficiaries: 9,902
Providers billing it: 370
Total allowed: $1,057,007

What Medicare pays for CPT 01996

Across 16,904 services billed by 370 providers to 9,902 beneficiaries, Medicare allowed an average of $62.53 per service. That is 1.7 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 01996

Specialty	Services	Beneficiaries	Avg allowed	Providers
Anesthesiology	10,699	5,835	$61.71	278
Nurse Practitioner	4,415	3,004	$64.81	52
Pain Management	1,018	593	$62.86	26
Physician Assistant	547	355	$59.53	9
Certified Clinical Nurse Specialist	118	69	$60.44	3
Interventional Pain Management	76	25	$63.56	1
Physical Medicine and Rehabilitation	31	21	$68.41	1

01996 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	3,350	$67.84	$48.59	51
California	2,007	$63.76	$47.94	32
Massachusetts	1,118	$64.15	$47.48	27
Colorado	764	$60.98	$48.59	14
North Carolina	763	$58.11	$48.72	14
Missouri	713	$60.66	$47.49	13
Florida	712	$61.62	$47.38	26
Washington	709	$64.56	$48.66	15
Indiana	686	$58.17	$47.76	11
Oregon	575	$59.63	$47.75	10
Illinois	434	$65.01	$48.94	12
New Hampshire	433	$60.99	$46.84	7
Ohio	424	$59.52	$48.26	12
Pennsylvania	386	$61.55	$48.26	6
Minnesota	330	$58.60	$48.07	9
Wisconsin	317	$58.08	$48.14	9
Kansas	316	$58.44	$47.08	6
Texas	311	$63.16	$48.19	11
Iowa	296	$58.18	$48.10	6
Nebraska	278	$57.58	$47.56	8
Michigan	269	$61.83	$47.33	10
Maryland	264	$64.80	$48.21	3
Kentucky	243	$57.17	$48.33	10
Tennessee	242	$56.72	$48.74	7
Maine	232	$59.97	$47.69	9
Virginia	154	$59.61	$48.53	9
Georgia	142	$59.52	$48.72	4
Utah	113	$59.57	$47.19	4
South Carolina	110	$59.29	$48.16	6
Arkansas	52	$57.82	$48.67	3
New Mexico	42	$62.38	$47.51	1
West Virginia	39	$61.20	$47.55	2
New Jersey	33	$66.31	$49.06	1
Connecticut	25	$63.88	$48.69	1
Hawaii	22	$61.55	$48.86	1

Related codes

01922Anesthesia for x-ray or radiation therapy$135.98
01992Anesthesia for nerve block and injection procedure$117.33
01938Anesthesia for injection$85.34
01926Anesthesia for x-ray on artery of brain$227.98
01940Anesthesia for nerve destruction procedures on spine or spinal cord of$107.14
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.