How much does Medicare pay for HCPCS 0866T?

Medicare allowed an average of $76.86 per service and paid $60.95 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $353.29, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code 0866T?

Quantitative mri of the brain with comparison to previous mri scan with mri scan performed during the same visit. It was billed 2,110 times to 2,024 Medicare beneficiaries by 60 providers in 2024.

Does 0866T pay differently in an office than a hospital?

Yes. The allowed amount averaged $77.18 in an office setting and $21.04 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 0866T most?

Diagnostic Radiology, with 1,995 services from 58 clinicians. Next are Neurology, Physician Assistant.

HCPCS 0866T

Quantitative mri of the brain with comparison to previous mri scan with mri scan performed during the same visit

$76.86Medicare-allowed amount per service, averaged across 2,110 services

Providers submitted

$353.29

Asking price, not received

Medicare allowed

$76.86

The fee schedule figure

Medicare paid

$60.95

Balance is patient coinsurance

Providers submitted an average of $353.29 for this code and Medicare allowed $76.86 — 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 $60.95 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $77.18
Hospital / facility: $21.04

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. 2,098 services were billed in an office setting and 12 in a facility.

Services: 2,110
Beneficiaries: 2,024
Providers billing it: 60
Total allowed: $162,175

What Medicare pays for HCPCS 0866T

Across 2,110 services billed by 60 providers to 2,024 beneficiaries, Medicare allowed an average of $76.86 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 0866T

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	1,995	1,911	$74.70	58
Neurology	89	87	$129.85	1
Physician Assistant	26	26	$61.00	1

0866T 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
Ohio	531	$72.35	$57.74	3
New Jersey	382	$70.70	$56.39	14
Maryland	258	$63.14	$49.30	9
California	165	$138.02	$108.98	6
Florida	164	$68.09	$53.79	7
Georgia	96	$68.90	$53.30	1
Texas	93	$24.74	$19.44	3
Arizona	91	$126.18	$98.43	5
Nevada	89	$129.85	$103.82	1
District of Columbia	80	$82.03	$65.25	1
Colorado	46	$67.55	$53.82	3
Michigan	42	$65.50	$52.71	2
Maine	28	$31.66	$25.15	2
Minnesota	18	$36.87	$29.30	1
Delaware	16	$21.88	$16.36	1
New York	11	$22.25	$17.73	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.