How much does Medicare pay for CPT 10160?

Medicare allowed an average of $112.33 per service and paid $86.32 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $253.18, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 10160?

Aspiration of abscess, blood, or cyst. It was billed 12,885 times to 8,213 Medicare beneficiaries by 250 providers in 2024.

Does 10160 pay differently in an office than a hospital?

Yes. The allowed amount averaged $115.96 in an office setting and $82.70 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 10160 most?

Podiatry, with 6,325 services from 87 clinicians. Next are General Surgery, Family Practice, Diagnostic Radiology.

CPT 10160

Aspiration of abscess, blood, or cyst

$112.33Medicare-allowed amount per service, averaged across 12,885 services

Providers submitted

$253.18

Asking price, not received

Medicare allowed

$112.33

The fee schedule figure

Medicare paid

$86.32

Balance is patient coinsurance

Providers submitted an average of $253.18 for this code and Medicare allowed $112.33 — 2.3× 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 $86.32 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $115.96
Hospital / facility: $82.70

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. 11,479 services were billed in an office setting and 1,406 in a facility.

Services: 12,885
Beneficiaries: 8,213
Providers billing it: 250
Total allowed: $1,447,372

What Medicare pays for CPT 10160

Across 12,885 services billed by 250 providers to 8,213 beneficiaries, Medicare allowed an average of $112.33 per service. That is 1.6 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 10160

Specialty	Services	Beneficiaries	Avg allowed	Providers
Podiatry	6,325	4,577	$125.57	87
General Surgery	1,031	499	$109.57	19
Family Practice	899	419	$92.18	13
Diagnostic Radiology	813	689	$92.43	49
Emergency Medicine	704	371	$109.19	7
Interventional Cardiology	464	104	$74.56	4
Vascular Surgery	360	180	$111.40	6
Internal Medicine	315	151	$113.58	5
Dermatology	307	226	$115.40	6
Sports Medicine	213	138	$114.82	6
General Practice	213	83	$84.59	3
Nurse Practitioner	206	116	$91.19	6
Cardiac Surgery	176	103	$85.49	2
Physician Assistant	170	113	$87.00	7
Interventional Radiology	162	144	$94.60	12

10160 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	2,670	$143.08	$96.59	34
Florida	1,936	$110.79	$84.34	35
California	1,770	$113.19	$75.76	29
Pennsylvania	932	$119.07	$88.80	16
Illinois	883	$98.31	$72.08	9
Michigan	535	$108.79	$82.84	6
Maryland	477	$90.31	$61.94	12
Arizona	434	$88.21	$71.95	9
Missouri	429	$75.40	$49.76	9
Louisiana	339	$96.29	$60.73	1
New Jersey	276	$124.57	$92.34	11
Texas	273	$98.91	$78.54	14
Tennessee	272	$98.01	$75.74	8
North Carolina	209	$82.28	$70.26	7
Nebraska	166	$101.30	$81.94	5
Kansas	146	$111.56	$88.53	3
South Carolina	133	$74.44	$57.45	4
Virginia	116	$116.17	$86.04	6
Oregon	102	$103.97	$85.68	4
Indiana	97	$72.91	$65.33	4
Arkansas	95	$91.91	$78.37	2
Georgia	82	$102.04	$83.62	2
Washington	79	$93.54	$69.49	2
Wisconsin	75	$100.54	$83.60	3
Ohio	56	$101.44	$71.58	2
Massachusetts	52	$129.74	$91.86	1
Connecticut	50	$68.58	$47.43	1
Mississippi	37	$116.00	$93.42	2
District of Columbia	37	$84.51	$58.85	2
Vermont	25	$122.80	$84.17	1
Alabama	22	$107.54	$93.84	1
Iowa	20	$87.90	$72.71	1
New Mexico	19	$122.46	$97.01	1
Delaware	15	$91.54	$68.12	1
Alaska	15	$109.70	$68.92	1
Kentucky	11	$84.60	$68.65	1

Related codes

10140Drainage of blood or fluid accumulation$159.34
10120Removal of foreign body from tissue$135.43

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.