How much does Medicare pay for CPT 11981?

Medicare allowed an average of $31.39 per service and paid $24.97 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $380.74, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 11981?

Insertion of drug delivery implant into tissue. It was billed 2,616 times to 2,395 Medicare beneficiaries by 79 providers in 2024.

Does 11981 pay differently in an office than a hospital?

Yes. The allowed amount averaged $105.74 in an office setting and $30.06 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 11981 most?

Orthopedic Surgery, with 2,053 services from 53 clinicians. Next are Clinical Cardiac Electrophysiology, Physician Assistant, Interventional Cardiology.

CPT 11981

Insertion of drug delivery implant into tissue

$31.39Medicare-allowed amount per service, averaged across 2,616 services

Providers submitted

$380.74

Asking price, not received

Medicare allowed

$31.39

The fee schedule figure

Medicare paid

$24.97

Balance is patient coinsurance

Providers submitted an average of $380.74 for this code and Medicare allowed $31.39 — 12.1× 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 $24.97 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $105.74
Hospital / facility: $30.06

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. 46 services were billed in an office setting and 2,570 in a facility.

Services: 2,616
Beneficiaries: 2,395
Providers billing it: 79
Total allowed: $82,116

What Medicare pays for CPT 11981

Across 2,616 services billed by 79 providers to 2,395 beneficiaries, Medicare allowed an average of $31.39 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 11981

Specialty	Services	Beneficiaries	Avg allowed	Providers
Orthopedic Surgery	2,053	1,870	$31.30	53
Clinical Cardiac Electrophysiology	95	95	$30.89	2
Physician Assistant	91	89	$4.67	6
Interventional Cardiology	73	73	$29.35	2
Plastic and Reconstructive Surgery	70	66	$35.82	5
Podiatry	63	57	$30.76	3
Urology	46	22	$105.74	1
Nurse Practitioner	29	27	$3.97	1
Neurosurgery	20	20	$32.60	1
Cardiology	19	19	$29.30	1
Cardiac Surgery	18	18	$28.06	1
Sports Medicine	13	13	$31.88	1
Thoracic Surgery	13	13	$33.82	1
Anesthesiology	13	13	$27.90	1

11981 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	846	$30.53	$24.40	9
California	484	$30.38	$22.04	18
South Carolina	187	$30.13	$25.15	5
Arizona	133	$22.24	$17.91	5
Maryland	120	$27.93	$20.92	3
Florida	117	$37.29	$24.79	6
Virginia	115	$30.76	$24.57	3
Indiana	89	$20.80	$17.57	4
Alabama	61	$34.56	$27.30	2
New York	57	$91.52	$64.97	2
West Virginia	50	$33.12	$25.53	3
Michigan	43	$31.53	$24.46	2
Kansas	39	$22.11	$16.76	2
North Carolina	39	$30.50	$24.30	2
Idaho	32	$27.90	$24.37	1
Kentucky	28	$31.42	$24.35	1
Louisiana	23	$32.79	$24.27	1
Colorado	21	$30.51	$24.38	1
Connecticut	20	$32.60	$24.41	1
Tennessee	18	$35.72	$24.23	1
Ohio	17	$31.16	$24.29	1
Missouri	14	$29.99	$24.35	1
Nebraska	14	$27.50	$24.37	1
District of Columbia	13	$33.82	$24.35	1
Wisconsin	13	$27.90	$24.35	1
Mississippi	12	$43.07	$30.50	1
Oklahoma	11	$34.77	$24.92	1

Related codes

11900Injection into skin growth$45.52
11901Injection into skin growth$62.69
11980Placement of hormone pellet under skin$85.14

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.