How much does Medicare pay for CPT 10005?

Medicare allowed an average of $99.08 per service and paid $75.36 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $468.95, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 10005?

Fine needle aspiration biopsy using ultrasound guidance, first growth. It was billed 92,730 times to 88,497 Medicare beneficiaries by 3,490 providers in 2024.

Does 10005 pay differently in an office than a hospital?

Yes. The allowed amount averaged $129.69 in an office setting and $69.70 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 10005 most?

Diagnostic Radiology, with 32,605 services from 1,417 clinicians. Next are Endocrinology, Physician Assistant, Interventional Radiology.

CPT 10005

Fine needle aspiration biopsy using ultrasound guidance, first growth

$99.08Medicare-allowed amount per service, averaged across 92,730 services

Providers submitted

$468.95

Asking price, not received

Medicare allowed

$99.08

The fee schedule figure

Medicare paid

$75.36

Balance is patient coinsurance

Providers submitted an average of $468.95 for this code and Medicare allowed $99.08 — 4.7× 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 $75.36 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $129.69
Hospital / facility: $69.70

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. 45,412 services were billed in an office setting and 47,318 in a facility.

Services: 92,730
Beneficiaries: 88,497
Providers billing it: 3,490
Total allowed: $9,187,688

What Medicare pays for CPT 10005

Across 92,730 services billed by 3,490 providers to 88,497 beneficiaries, Medicare allowed an average of $99.08 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 10005

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	32,605	32,124	$88.48	1,417
Endocrinology	16,297	15,317	$124.57	595
Physician Assistant	10,022	9,852	$62.94	354
Interventional Radiology	8,406	8,334	$80.68	407
Otolaryngology	6,493	6,114	$121.46	264
Pathology	6,453	6,204	$115.40	82
General Surgery	4,262	3,951	$121.13	139
Internal Medicine	3,491	2,329	$128.59	79
Nurse Practitioner	2,620	2,581	$63.34	98
Surgical Oncology	527	482	$103.74	18
Clinical Laboratory	408	402	$128.05	2
Family Practice	350	62	$139.06	2
Ambulatory Surgical Center	233	231	$355.07	5
Urology	90	89	$64.41	6
Interventional Cardiology	89	88	$72.06	3

10005 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	10,305	$114.72	$79.55	327
New York	9,974	$122.44	$83.71	252
Florida	6,979	$106.13	$78.85	280
Texas	6,059	$96.07	$74.44	233
Illinois	4,233	$91.05	$65.68	164
Pennsylvania	4,004	$78.60	$58.94	172
New Jersey	3,730	$111.65	$78.06	122
Massachusetts	3,027	$99.55	$70.80	108
Georgia	2,499	$98.21	$74.82	91
Virginia	2,468	$89.34	$67.82	93
North Carolina	2,386	$92.51	$73.93	109
Tennessee	2,237	$103.32	$85.44	76
Arizona	2,232	$105.16	$80.71	73
Maryland	2,186	$99.15	$71.74	86
Ohio	2,163	$88.56	$70.56	95
South Carolina	1,964	$77.74	$61.29	57
Michigan	1,836	$85.73	$64.00	93
Indiana	1,789	$87.34	$70.55	65
Missouri	1,668	$79.80	$64.08	73
Washington	1,615	$87.37	$63.28	78
Oklahoma	1,336	$81.47	$66.73	51
Wisconsin	1,242	$86.31	$67.58	60
Minnesota	1,203	$84.38	$64.80	62
Colorado	957	$77.30	$58.58	50
Nevada	948	$107.86	$81.48	34
Iowa	895	$84.90	$69.37	39
Delaware	872	$104.06	$76.54	20
Louisiana	871	$91.97	$73.81	34
Connecticut	837	$94.96	$70.04	30
Arkansas	816	$91.08	$77.21	30
Oregon	805	$95.16	$70.49	36
Kansas	803	$91.12	$74.57	28
Alabama	747	$98.73	$83.81	38
Kentucky	737	$77.42	$61.52	36
Nebraska	722	$118.58	$97.92	29
Utah	669	$87.41	$69.45	33
West Virginia	538	$76.88	$59.72	23
New Hampshire	450	$80.67	$60.37	23
District of Columbia	445	$112.64	$80.19	17
Mississippi	379	$98.20	$82.56	18
New Mexico	372	$81.70	$62.19	20
South Dakota	335	$77.32	$60.38	14
Montana	328	$89.55	$69.24	17
Maine	291	$75.85	$58.89	14
Wyoming	288	$89.59	$69.00	14
Alaska	258	$99.91	$59.27	12
Vermont	245	$75.29	$58.12	11
Rhode Island	231	$97.61	$72.18	10
North Dakota	218	$66.77	$51.84	10
Idaho	211	$60.48	$47.94	13
Puerto Rico	161	$94.28	$70.39	7
Hawaii	117	$87.55	$62.54	7
AA	19	$66.82	$45.75	1
U.S. Virgin Islands	17	$129.36	$98.67	1
AP	13	$125.97	$105.04	1

Related codes

10060Simple or single drainage of skin abscess$124.11
10061Complicated or multiple drainage of skin abscess$210.58
10040Acne surgery$109.41
10006Fine needle aspiration biopsy$56.90
10021Fine needle aspiration biopsy$74.12

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.