How much does Medicare pay for CPT 15004?

Medicare allowed an average of $298.29 per service and paid $237.36 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1224.51, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does 15004 pay differently in an office than a hospital?

Yes. The allowed amount averaged $396.11 in an office setting and $225.17 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 15004 most?

Plastic and Reconstructive Surgery, with 6,401 services from 152 clinicians. Next are Otolaryngology, Ambulatory Surgical Center, Podiatry.

CPT 15004

Preparation of skin graft site of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 100.0 sq cm or 1% body area for infants and children, or less

$298.29Medicare-allowed amount per service, averaged across 22,621 services

Providers submitted

$1224.51

Asking price, not received

Medicare allowed

$298.29

The fee schedule figure

Medicare paid

$237.36

Balance is patient coinsurance

Providers submitted an average of $1224.51 for this code and Medicare allowed $298.29 — 4.1× 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 $237.36 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $396.11
Hospital / facility: $225.17

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. 9,676 services were billed in an office setting and 12,945 in a facility.

Services: 22,621
Beneficiaries: 18,087
Providers billing it: 502
Total allowed: $6,747,618

What Medicare pays for CPT 15004

Across 22,621 services billed by 502 providers to 18,087 beneficiaries, Medicare allowed an average of $298.29 per service. That is 1.3 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 15004

Specialty	Services	Beneficiaries	Avg allowed	Providers
Plastic and Reconstructive Surgery	6,401	5,685	$334.00	152
Otolaryngology	3,786	3,321	$318.25	77
Ambulatory Surgical Center	3,297	2,906	$172.62	56
Podiatry	2,738	1,373	$338.45	69
Dermatology	2,019	1,473	$355.47	35
Ophthalmology	1,304	1,131	$323.31	41
General Surgery	1,082	719	$275.56	24
Physician Assistant	602	530	$56.32	14
Nurse Practitioner	507	290	$306.07	6
Micrographic Dermatologic Surgery	383	339	$389.39	11
Undersea and Hyperbaric Medicine	169	59	$277.79	2
Hand Surgery	131	103	$241.20	7
Critical Care (Intensivists)	84	47	$260.10	1
Maxillofacial Surgery	52	45	$241.77	2
Emergency Medicine	16	16	$261.38	1

15004 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
Florida	3,465	$354.44	$268.09	67
California	2,504	$345.02	$247.19	47
New York	1,942	$393.14	$274.53	40
Delaware	1,914	$213.01	$169.10	8
Arizona	1,890	$244.18	$192.94	23
Georgia	1,312	$228.73	$187.17	29
Maryland	1,178	$248.28	$193.90	24
Texas	1,091	$315.97	$255.63	34
Virginia	805	$310.11	$251.70	19
Illinois	699	$376.78	$278.69	17
New Jersey	576	$322.89	$235.86	17
Kentucky	465	$304.83	$258.17	8
Tennessee	409	$226.21	$196.41	16
Oklahoma	385	$257.45	$220.79	9
Ohio	322	$305.59	$249.70	14
Nevada	315	$240.26	$192.17	6
Massachusetts	274	$286.36	$211.96	10
Michigan	246	$89.72	$68.85	5
Washington	236	$263.66	$210.72	9
District of Columbia	214	$347.28	$244.21	3
Pennsylvania	209	$265.57	$209.53	13
Louisiana	196	$362.96	$298.87	4
Missouri	194	$224.27	$184.54	7
Mississippi	175	$276.29	$230.92	4
North Carolina	156	$231.55	$200.99	7
Alabama	142	$257.50	$230.02	5
Colorado	131	$306.92	$236.48	5
Minnesota	130	$258.38	$205.57	8
Indiana	129	$245.63	$200.83	4
Nebraska	126	$222.60	$191.34	5
South Carolina	120	$272.77	$222.72	7
South Dakota	105	$237.57	$191.21	3
Kansas	78	$273.80	$241.28	3
Rhode Island	69	$255.74	$200.88	2
Oregon	66	$310.11	$224.82	4
Arkansas	64	$298.41	$258.60	3
Wisconsin	60	$262.88	$227.76	2
Guam	55	$368.89	$307.74	1
North Dakota	44	$240.96	$196.93	1
Connecticut	34	$330.67	$247.31	2
Utah	28	$247.10	$200.62	2
New Mexico	22	$188.34	$164.16	2
West Virginia	19	$247.11	$200.52	1
Idaho	16	$233.68	$194.56	1
Iowa	11	$329.01	$306.00	1

Related codes

15003Preparation of skin graft site of trunk$37.11
15002Preparation of skin graft site of trunk$270.10

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.