How much does Medicare pay for HCPCS 0509T?

Medicare allowed an average of $71.67 per service and paid $52.69 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $169.77, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code 0509T?

Pattern recording of retinal electrical responses to external stimuli with interpretation and report. It was billed 8,775 times to 7,922 Medicare beneficiaries by 97 providers in 2024.

Does 0509T pay differently in an office than a hospital?

Yes. The allowed amount averaged $71.74 in an office setting and $19.74 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 0509T most?

Ophthalmology, with 5,450 services from 39 clinicians. Next are Optometry.

HCPCS 0509T

Pattern recording of retinal electrical responses to external stimuli with interpretation and report

$71.67Medicare-allowed amount per service, averaged across 8,775 services

Providers submitted

$169.77

Asking price, not received

Medicare allowed

$71.67

The fee schedule figure

Medicare paid

$52.69

Balance is patient coinsurance

Providers submitted an average of $169.77 for this code and Medicare allowed $71.67 — 2.4× 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 $52.69 (74%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $71.74
Hospital / facility: $19.74

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. 8,764 services were billed in an office setting and 11 in a facility.

Services: 8,775
Beneficiaries: 7,922
Providers billing it: 97
Total allowed: $628,904

What Medicare pays for HCPCS 0509T

Across 8,775 services billed by 97 providers to 7,922 beneficiaries, Medicare allowed an average of $71.67 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 0509T

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	5,450	5,064	$73.06	39
Optometry	3,325	2,858	$69.39	58

0509T 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
Florida	1,547	$72.06	$52.32	20
California	1,137	$78.30	$52.31	7
New Jersey	1,090	$83.28	$54.74	4
Texas	762	$65.81	$51.31	12
Illinois	680	$66.67	$48.95	4
Ohio	526	$58.46	$48.41	7
Oklahoma	462	$68.25	$52.92	4
Pennsylvania	386	$65.71	$43.80	6
Indiana	313	$63.31	$49.87	1
Virginia	313	$86.87	$43.88	3
Michigan	280	$65.30	$50.61	2
North Carolina	231	$63.85	$59.22	1
New York	182	$80.92	$51.79	5
Washington	150	$69.57	$44.83	2
Arkansas	132	$58.28	$50.34	2
Kentucky	110	$73.05	$56.23	1
Puerto Rico	95	$66.14	$50.18	1
Maine	83	$75.02	$56.76	2
Louisiana	54	$67.71	$48.93	3
New Mexico	53	$59.25	$48.14	1
Oregon	52	$85.99	$59.02	1
Minnesota	33	$64.52	$50.74	1
Missouri	24	$75.68	$49.95	2
Connecticut	22	$72.95	$48.41	1
Maryland	17	$76.61	$55.43	1
Mississippi	14	$65.51	$59.50	1
Delaware	14	$70.27	$51.99	1
Massachusetts	13	$80.54	$50.27	1

Related codes

0507TNear infrared dual imaging of tear glands$24.67

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.