How much does Medicare pay for CPT 11980?

Medicare allowed an average of $85.14 per service and paid $63.88 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $266.21, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 11980?

Placement of hormone pellet under skin. It was billed 14,816 times to 6,780 Medicare beneficiaries by 226 providers in 2024.

Does 11980 pay differently in an office than a hospital?

Yes. The allowed amount averaged $85.76 in an office setting and $52.89 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 11980 most?

Urology, with 8,259 services from 125 clinicians. Next are Physician Assistant, Nurse Practitioner, Obstetrics & Gynecology.

CPT 11980

Placement of hormone pellet under skin

$85.14Medicare-allowed amount per service, averaged across 14,816 services

Providers submitted

$266.21

Asking price, not received

Medicare allowed

$85.14

The fee schedule figure

Medicare paid

$63.88

Balance is patient coinsurance

Providers submitted an average of $266.21 for this code and Medicare allowed $85.14 — 3.1× 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 $63.88 (75%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $85.76
Hospital / facility: $52.89

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. 14,536 services were billed in an office setting and 280 in a facility.

Services: 14,816
Beneficiaries: 6,780
Providers billing it: 226
Total allowed: $1,261,434

What Medicare pays for CPT 11980

Across 14,816 services billed by 226 providers to 6,780 beneficiaries, Medicare allowed an average of $85.14 per service. That is 2.2 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 11980

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	8,259	3,639	$92.30	125
Physician Assistant	2,075	981	$77.06	35
Nurse Practitioner	2,071	1,005	$73.34	33
Obstetrics & Gynecology	1,481	743	$72.43	19
Family Practice	454	182	$86.52	3
Cardiology	154	79	$94.58	2
General Practice	113	33	$86.14	1
Internal Medicine	78	53	$95.56	4
Endocrinology	60	34	$75.41	2
General Surgery	46	19	$49.44	1
Emergency Medicine	25	12	$93.29	1

11980 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
Texas	3,083	$87.24	$65.81	42
Florida	3,006	$79.79	$65.74	34
California	1,624	$91.90	$61.98	23
South Carolina	876	$78.71	$62.32	13
Tennessee	844	$81.80	$63.58	8
Massachusetts	536	$96.06	$65.94	8
New York	532	$97.99	$65.29	10
Illinois	523	$87.94	$62.01	9
Arkansas	468	$70.00	$58.27	6
North Carolina	406	$85.92	$66.19	10
Maryland	299	$87.84	$64.73	6
New Jersey	259	$103.30	$70.70	3
Delaware	256	$93.76	$64.12	3
Louisiana	245	$84.98	$71.55	6
Colorado	241	$89.27	$61.51	8
Arizona	224	$80.84	$62.46	5
Ohio	209	$76.02	$59.66	5
Virginia	209	$91.85	$69.35	4
Missouri	166	$81.53	$59.61	2
Georgia	143	$77.31	$64.43	4
Pennsylvania	142	$64.35	$43.62	3
Utah	102	$84.99	$63.91	1
Indiana	101	$85.19	$71.20	2
Kansas	85	$85.65	$65.46	2
Washington	38	$104.63	$71.73	1
Oregon	33	$78.61	$59.83	1
Kentucky	31	$67.37	$60.55	1
Mississippi	30	$68.82	$59.50	1
Vermont	29	$51.52	$38.81	1
Idaho	26	$73.12	$58.39	1
Montana	23	$46.37	$36.89	1
Minnesota	14	$71.72	$62.26	1
Nevada	13	$91.84	$67.68	1

Related codes

11900Injection into skin growth$45.52
11901Injection into skin growth$62.69
11981Insertion of drug delivery implant into tissue$31.39

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.