How much does Medicare pay for HCPCS 0421T?

Medicare allowed an average of $791.73 per service and paid $626.94 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $3607.19, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code 0421T?

Waterjet destruction of prostrate accessed through the urethra. It was billed 5,247 times to 5,245 Medicare beneficiaries by 261 providers in 2024.

Does 0421T pay differently in an office than a hospital?

Yes. The allowed amount averaged $716.15 in an office setting and $792.96 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 0421T most?

Urology, with 5,184 services from 258 clinicians. Next are Ambulatory Surgical Center, Osteopathic Manipulative Medicine, General Surgery.

HCPCS 0421T

Waterjet destruction of prostrate accessed through the urethra

$791.73Medicare-allowed amount per service, averaged across 5,247 services

Providers submitted

$3607.19

Asking price, not received

Medicare allowed

$791.73

The fee schedule figure

Medicare paid

$626.94

Balance is patient coinsurance

Providers submitted an average of $3607.19 for this code and Medicare allowed $791.73 — 4.6× 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 $626.94 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $716.15
Hospital / facility: $792.96

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 84 services were billed in an office setting and 5,163 in a facility.

Services: 5,247
Beneficiaries: 5,245
Providers billing it: 261
Total allowed: $4,154,207

What Medicare pays for HCPCS 0421T

Across 5,247 services billed by 261 providers to 5,245 beneficiaries, Medicare allowed an average of $791.73 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 0421T

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	5,184	5,182	$749.50	258
Ambulatory Surgical Center	41	41	$6177.42	1
Osteopathic Manipulative Medicine	11	11	$670.28	1
General Surgery	11	11	$742.53	1

0421T 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
California	743	$772.52	$608.88	38
New York	527	$903.70	$709.70	15
Florida	472	$701.29	$551.55	27
Georgia	283	$708.32	$559.14	16
Virginia	277	$699.53	$554.35	8
Texas	253	$675.80	$530.41	14
Illinois	223	$819.82	$646.83	12
Pennsylvania	220	$695.76	$548.70	12
Washington	179	$729.04	$584.56	10
Colorado	170	$684.40	$534.90	8
Kansas	161	$816.59	$626.32	8
Missouri	158	$834.73	$645.69	8
Ohio	147	$709.86	$568.05	9
Tennessee	133	$575.09	$454.07	7
Nebraska	131	$775.42	$617.86	6
Arizona	124	$712.82	$564.57	7
Massachusetts	98	$827.92	$631.21	5
Indiana	84	$741.73	$599.41	5
New Jersey	82	$741.07	$578.11	5
Oregon	73	$730.36	$561.57	3
Nevada	72	$752.12	$597.89	5
District of Columbia	69	$783.39	$598.00	2
Minnesota	57	$756.45	$591.48	3
North Dakota	49	$700.66	$554.49	1
Louisiana	46	$662.57	$520.11	3
Montana	44	$748.73	$564.62	2
Arkansas	43	$621.86	$488.01	3
Maryland	41	$6177.42	$4863.01	1
Rhode Island	40	$797.38	$635.31	2
Utah	40	$697.45	$563.19	2
West Virginia	36	$638.02	$513.51	3
North Carolina	32	$677.83	$491.18	1
New Hampshire	29	$735.65	$584.89	1
Wisconsin	26	$731.98	$568.80	2
Kentucky	24	$719.13	$534.82	2
South Carolina	23	$640.16	$506.19	2
Oklahoma	16	$642.66	$494.02	1
Idaho	11	$670.28	$534.04	1
Michigan	11	$890.35	$709.38	1

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.