How much does Medicare pay for CPT 10021?

Medicare allowed an average of $74.12 per service and paid $56.89 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $505.03, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 10021?

Fine needle aspiration biopsy, first growth. It was billed 1,381 times to 1,249 Medicare beneficiaries by 70 providers in 2024.

Does 10021 pay differently in an office than a hospital?

Yes. The allowed amount averaged $87.69 in an office setting and $54.17 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 10021 most?

Pathology, with 499 services from 30 clinicians. Next are Otolaryngology, Interventional Pain Management, Nurse Practitioner.

CPT 10021

Fine needle aspiration biopsy, first growth

$74.12Medicare-allowed amount per service, averaged across 1,381 services

Providers submitted

$505.03

Asking price, not received

Medicare allowed

$74.12

The fee schedule figure

Medicare paid

$56.89

Balance is patient coinsurance

Providers submitted an average of $505.03 for this code and Medicare allowed $74.12 — 6.8× 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 $56.89 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $87.69
Hospital / facility: $54.17

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. 822 services were billed in an office setting and 559 in a facility.

Services: 1,381
Beneficiaries: 1,249
Providers billing it: 70
Total allowed: $102,360

What Medicare pays for CPT 10021

Across 1,381 services billed by 70 providers to 1,249 beneficiaries, Medicare allowed an average of $74.12 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 10021

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pathology	499	496	$61.40	30
Otolaryngology	424	401	$85.88	25
Interventional Pain Management	156	71	$74.71	1
Nurse Practitioner	105	105	$48.37	3
General Surgery	61	57	$86.80	4
Endocrinology	56	56	$97.60	3
Physical Medicine and Rehabilitation	40	23	$109.36	1
Neurology	28	28	$100.10	2
Ophthalmology	12	12	$53.12	1

10021 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	182	$89.29	$61.82	9
Washington	156	$74.71	$57.53	1
California	135	$71.23	$47.61	9
Massachusetts	130	$49.84	$35.26	5
Texas	101	$59.19	$39.34	6
Arizona	86	$92.99	$73.13	4
District of Columbia	65	$93.78	$62.42	2
Maryland	60	$78.62	$52.38	3
Pennsylvania	52	$81.00	$61.18	4
Arkansas	49	$49.02	$37.40	3
Illinois	46	$73.67	$51.79	3
Oklahoma	38	$83.11	$72.13	2
South Carolina	33	$82.20	$68.37	2
Virginia	31	$70.85	$55.39	2
Florida	26	$73.34	$53.24	2
North Carolina	25	$72.69	$54.18	2
Oregon	24	$73.72	$60.29	2
Delaware	23	$91.00	$72.36	1
Connecticut	20	$58.48	$40.22	1
Ohio	17	$52.05	$39.91	1
Georgia	17	$80.16	$59.25	1
Kentucky	16	$54.33	$42.41	1
Kansas	14	$88.06	$65.94	1
Michigan	13	$94.15	$68.99	1
New Jersey	11	$56.01	$40.54	1
Minnesota	11	$50.57	$25.30	1

Related codes

10060Simple or single drainage of skin abscess$124.11
10005Fine needle aspiration biopsy$99.08
10061Complicated or multiple drainage of skin abscess$210.58
10040Acne surgery$109.41
10006Fine needle aspiration biopsy$56.90

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.