How much does Medicare pay for CPT 15852?

Medicare allowed an average of $26.22 per service and paid $20.58 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $93.00, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 15852?

Dressing change under anesthesia. It was billed 3,459 times to 1,129 Medicare beneficiaries by 37 providers in 2024.

Does 15852 pay differently in an office than a hospital?

Yes. The allowed amount averaged $25.97 in an office setting and $36.48 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 15852 most?

Nurse Practitioner, with 2,133 services from 18 clinicians. Next are Podiatry, Certified Clinical Nurse Specialist, Rheumatology.

CPT 15852

Dressing change under anesthesia

$26.22Medicare-allowed amount per service, averaged across 3,459 services

Providers submitted

$93.00

Asking price, not received

Medicare allowed

$26.22

The fee schedule figure

Medicare paid

$20.58

Balance is patient coinsurance

Providers submitted an average of $93.00 for this code and Medicare allowed $26.22 — 3.5× 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 $20.58 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $25.97
Hospital / facility: $36.48

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 3,377 services were billed in an office setting and 82 in a facility.

Services: 3,459
Beneficiaries: 1,129
Providers billing it: 37
Total allowed: $90,695

What Medicare pays for CPT 15852

Across 3,459 services billed by 37 providers to 1,129 beneficiaries, Medicare allowed an average of $26.22 per service. That is 3.1 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 15852

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	2,133	441	$22.79	18
Podiatry	391	316	$23.51	2
Certified Clinical Nurse Specialist	310	52	$21.09	2
Rheumatology	203	30	$46.90	1
Dermatology	159	115	$45.43	4
General Surgery	64	33	$34.43	2
Family Practice	55	33	$42.10	2
Plastic and Reconstructive Surgery	45	22	$37.51	1
Physician Assistant	40	36	$39.51	2
Internal Medicine	34	29	$18.54	2
Emergency Medicine	25	22	$48.02	1

15852 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	1,694	$23.42	$18.81	12
Missouri	415	$19.55	$15.99	2
Illinois	391	$23.51	$18.23	2
New York	355	$44.48	$30.43	6
Oklahoma	147	$19.52	$16.55	1
Kansas	78	$20.53	$18.06	2
Michigan	78	$23.51	$19.10	1
Pennsylvania	76	$50.28	$33.69	1
Arizona	69	$38.80	$29.65	3
Massachusetts	45	$37.51	$25.75	1
New Jersey	35	$20.74	$31.33	2
California	25	$37.98	$27.63	1
Virginia	23	$42.29	$33.21	1
Alabama	15	$27.29	$23.57	1
Georgia	13	$28.98	$21.31	1

Related codes

15823Removal of excessive skin and fat of upper eyelid$694.81
15853Removal of sutures or staples$11.48
15860Injection of agent into vein to assess blood flow of skin graft or fla$53.69

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.