How much does Medicare pay for CPT 15769?

Medicare allowed an average of $431.80 per service and paid $343.76 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $2701.81, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 15769?

Self soft tissue graft. It was billed 2,208 times to 2,052 Medicare beneficiaries by 77 providers in 2024.

Does 15769 pay differently in an office than a hospital?

Yes. The allowed amount averaged $339.12 in an office setting and $441.96 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 15769 most?

Otolaryngology, with 624 services from 32 clinicians. Next are Orthopedic Surgery, Ambulatory Surgical Center, Neurosurgery.

CPT 15769

Self soft tissue graft

$431.80Medicare-allowed amount per service, averaged across 2,208 services

Providers submitted

$2701.81

Asking price, not received

Medicare allowed

$431.80

The fee schedule figure

Medicare paid

$343.76

Balance is patient coinsurance

Providers submitted an average of $2701.81 for this code and Medicare allowed $431.80 — 6.3× 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 $343.76 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $339.12
Hospital / facility: $441.96

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 218 services were billed in an office setting and 1,990 in a facility.

Services: 2,208
Beneficiaries: 2,052
Providers billing it: 77
Total allowed: $953,414

What Medicare pays for CPT 15769

Across 2,208 services billed by 77 providers to 2,052 beneficiaries, Medicare allowed an average of $431.80 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 15769

Specialty	Services	Beneficiaries	Avg allowed	Providers
Otolaryngology	624	609	$243.48	32
Orthopedic Surgery	494	472	$265.53	9
Ambulatory Surgical Center	397	324	$1208.80	13
Neurosurgery	324	319	$238.68	12
Plastic and Reconstructive Surgery	148	124	$259.74	2
General Practice	48	39	$486.27	1
General Surgery	44	44	$252.49	2
Cardiac Surgery	37	37	$235.29	1
Micrographic Dermatologic Surgery	29	28	$256.83	1
Ophthalmology	17	17	$292.92	1
Pain Management	17	11	$497.76	1
Obstetrics & Gynecology	15	15	$239.58	1
Family Practice	14	13	$501.22	1

15769 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	393	$722.15	$603.11	9
California	301	$446.25	$304.93	9
Washington	260	$478.26	$348.90	8
Texas	228	$314.02	$249.74	7
Maryland	128	$452.94	$350.26	6
Georgia	121	$251.35	$193.64	3
New York	116	$543.97	$372.78	4
Arizona	92	$498.35	$402.37	4
Massachusetts	77	$241.43	$193.49	1
Delaware	66	$232.91	$194.33	1
Michigan	48	$241.78	$189.55	2
Utah	33	$230.93	$188.20	2
Ohio	33	$230.27	$195.45	2
South Carolina	33	$230.18	$188.39	1
North Carolina	32	$238.46	$188.85	2
Colorado	31	$239.24	$188.25	1
Missouri	27	$222.84	$189.87	2
Mississippi	26	$200.88	$190.65	2
Oklahoma	26	$223.48	$188.00	1
New Jersey	18	$268.86	$188.44	1
Arkansas	15	$225.90	$213.73	1
Alabama	15	$765.47	$741.62	1
Illinois	14	$300.68	$201.78	1
Montana	14	$235.31	$187.85	1
Pennsylvania	14	$238.73	$191.66	1
Tennessee	13	$216.06	$188.47	1
Oregon	12	$274.66	$204.70	1
Wisconsin	11	$217.76	$188.11	1
Minnesota	11	$225.05	$188.67	1

Related codes

15734Creation of muscle graft to trunk$1018.35
15733Creation of flap graft to head and/or neck$961.01
15730Creation of flap graft to midface$1178.73

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.