How much does Medicare pay for CPT 15630?

Medicare allowed an average of $438.36 per service and paid $341.53 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1690.32, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 15630?

Transfer of skin flap to eyelids, nose, ears, or lips. It was billed 1,027 times to 992 Medicare beneficiaries by 49 providers in 2024.

Does 15630 pay differently in an office than a hospital?

Yes. The allowed amount averaged $414.42 in an office setting and $459.86 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 15630 most?

Dermatology, with 256 services from 13 clinicians. Next are Micrographic Dermatologic Surgery, Otolaryngology, Ambulatory Surgical Center.

CPT 15630

Transfer of skin flap to eyelids, nose, ears, or lips

$438.36Medicare-allowed amount per service, averaged across 1,027 services

Providers submitted

$1690.32

Asking price, not received

Medicare allowed

$438.36

The fee schedule figure

Medicare paid

$341.53

Balance is patient coinsurance

Providers submitted an average of $1690.32 for this code and Medicare allowed $438.36 — 3.9× 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 $341.53 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $414.42
Hospital / facility: $459.86

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 486 services were billed in an office setting and 541 in a facility.

Services: 1,027
Beneficiaries: 992
Providers billing it: 49
Total allowed: $450,196

What Medicare pays for CPT 15630

Across 1,027 services billed by 49 providers to 992 beneficiaries, Medicare allowed an average of $438.36 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 15630

Specialty	Services	Beneficiaries	Avg allowed	Providers
Dermatology	256	246	$400.33	13
Micrographic Dermatologic Surgery	220	211	$397.10	7
Otolaryngology	200	193	$215.06	10
Ambulatory Surgical Center	169	166	$925.83	9
Plastic and Reconstructive Surgery	162	156	$337.80	9
Pathology	20	20	$307.38	1

15630 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
California	149	$484.82	$351.48	7
Washington	99	$590.64	$426.24	4
North Carolina	92	$423.12	$346.78	2
Oklahoma	78	$285.84	$231.84	3
South Carolina	63	$416.17	$341.81	1
Kansas	62	$520.53	$445.53	4
Arkansas	45	$485.50	$417.66	3
Texas	41	$248.37	$180.87	3
Illinois	40	$328.97	$248.49	2
Delaware	39	$522.64	$409.06	2
New York	37	$411.77	$305.88	2
Florida	35	$460.00	$350.11	2
Ohio	33	$268.11	$201.04	2
Missouri	31	$620.82	$508.76	2
Michigan	31	$361.24	$296.57	2
Wisconsin	26	$334.06	$248.50	1
Pennsylvania	26	$322.40	$233.43	1
Louisiana	24	$439.74	$346.92	1
Virginia	22	$891.33	$741.58	1
South Dakota	17	$327.85	$247.72	1
Tennessee	15	$163.52	$135.29	1
Alabama	11	$424.14	$345.86	1
North Dakota	11	$331.52	$270.09	1

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.