How much does Medicare pay for CPT 10040?

Medicare allowed an average of $109.41 per service and paid $80.08 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $231.62, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 10040?

Acne surgery. It was billed 32,061 times to 26,452 Medicare beneficiaries by 980 providers in 2024.

Does 10040 pay differently in an office than a hospital?

Yes. The allowed amount averaged $109.73 in an office setting and $28.80 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 10040 most?

Dermatology, with 22,438 services from 606 clinicians. Next are Physician Assistant, Nurse Practitioner, Internal Medicine.

CPT 10040

Acne surgery

$109.41Medicare-allowed amount per service, averaged across 32,061 services

Providers submitted

$231.62

Asking price, not received

Medicare allowed

$109.41

The fee schedule figure

Medicare paid

$80.08

Balance is patient coinsurance

Providers submitted an average of $231.62 for this code and Medicare allowed $109.41 — 2.1× 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 $80.08 (73%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $109.73
Hospital / facility: $28.80

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. 31,936 services were billed in an office setting and 125 in a facility.

Services: 32,061
Beneficiaries: 26,452
Providers billing it: 980
Total allowed: $3,507,794

What Medicare pays for CPT 10040

Across 32,061 services billed by 980 providers to 26,452 beneficiaries, Medicare allowed an average of $109.41 per service. That is 1.2 services per beneficiary, so this is a code patients typically receive more than once. 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 10040

Specialty	Services	Beneficiaries	Avg allowed	Providers
Dermatology	22,438	18,246	$114.60	606
Physician Assistant	5,626	5,030	$96.06	239
Nurse Practitioner	3,062	2,636	$97.03	114
Internal Medicine	265	102	$113.56	3
Plastic and Reconstructive Surgery	206	155	$95.04	6
Obstetrics & Gynecology	182	24	$98.59	1
Family Practice	136	125	$110.88	4
Micrographic Dermatologic Surgery	124	116	$106.19	6
Osteopathic Manipulative Medicine	22	18	$135.77	1

10040 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	8,031	$120.58	$77.90	196
Florida	6,097	$107.24	$76.22	183
New Jersey	4,540	$112.06	$75.26	102
Texas	3,110	$106.09	$76.97	106
Illinois	1,423	$107.26	$75.76	50
Maryland	1,162	$111.39	$76.62	34
Louisiana	782	$99.12	$79.48	29
Oklahoma	706	$95.75	$72.11	26
Iowa	700	$95.49	$72.71	26
Mississippi	681	$94.43	$75.67	22
Michigan	637	$109.79	$79.16	29
Pennsylvania	558	$109.70	$77.87	24
Arkansas	397	$76.08	$57.82	14
Massachusetts	371	$106.93	$75.77	11
Nebraska	341	$93.20	$70.67	14
Kentucky	325	$98.36	$83.62	6
Virginia	241	$121.67	$79.39	11
Delaware	213	$104.40	$77.12	7
Colorado	208	$108.21	$76.39	12
Minnesota	205	$91.84	$66.46	13
Missouri	181	$85.97	$67.04	12
Puerto Rico	151	$66.73	$51.48	3
Wisconsin	150	$102.33	$77.13	9
Indiana	120	$96.17	$68.87	7
District of Columbia	113	$118.87	$77.01	4
New Mexico	108	$99.77	$76.06	3
Ohio	101	$100.11	$67.61	3
Kansas	93	$96.38	$71.97	6
Rhode Island	79	$115.88	$78.70	4
Connecticut	70	$118.47	$77.73	4
New Hampshire	43	$114.93	$77.55	3
Idaho	40	$124.17	$83.02	1
California	36	$102.94	$74.84	3
Georgia	19	$89.91	$77.65	1
North Dakota	16	$85.54	$54.31	1
Maine	13	$76.48	$59.53	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
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.