How much does Medicare pay for CPT 20604?

Medicare allowed an average of $75.96 per service and paid $57.32 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $293.96, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 20604?

Aspiration and/or injection of fluid from small joint using ultrasound guidance. It was billed 39,755 times to 25,121 Medicare beneficiaries by 919 providers in 2024.

Does 20604 pay differently in an office than a hospital?

Yes. The allowed amount averaged $76.99 in an office setting and $45.08 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 20604 most?

Orthopedic Surgery, with 9,777 services from 175 clinicians. Next are Podiatry, Rheumatology, Hand Surgery.

CPT 20604

Aspiration and/or injection of fluid from small joint using ultrasound guidance

$75.96Medicare-allowed amount per service, averaged across 39,755 services

Providers submitted

$293.96

Asking price, not received

Medicare allowed

$75.96

The fee schedule figure

Medicare paid

$57.32

Balance is patient coinsurance

Providers submitted an average of $293.96 for this code and Medicare allowed $75.96 — 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 $57.32 (75%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $76.99
Hospital / facility: $45.08

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. 38,471 services were billed in an office setting and 1,284 in a facility.

Services: 39,755
Beneficiaries: 25,121
Providers billing it: 919
Total allowed: $3,019,790

What Medicare pays for CPT 20604

Across 39,755 services billed by 919 providers to 25,121 beneficiaries, Medicare allowed an average of $75.96 per service. That is 1.6 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 20604

Specialty	Services	Beneficiaries	Avg allowed	Providers
Orthopedic Surgery	9,777	6,046	$77.80	175
Podiatry	7,545	4,461	$75.59	168
Rheumatology	4,742	3,037	$80.78	119
Hand Surgery	4,707	3,398	$82.72	76
Sports Medicine	2,685	1,652	$70.14	85
Physical Medicine and Rehabilitation	2,491	1,486	$73.52	69
Physician Assistant	2,141	1,444	$68.53	61
Family Practice	1,927	1,148	$68.36	61
Nurse Practitioner	1,161	769	$68.58	28
Diagnostic Radiology	770	550	$55.22	25
Internal Medicine	606	370	$77.59	17
Plastic and Reconstructive Surgery	290	203	$83.59	4
Interventional Pain Management	227	122	$71.39	8
Emergency Medicine	221	110	$75.80	5
General Surgery	185	115	$85.52	5

20604 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	7,931	$77.79	$56.98	102
California	4,414	$83.29	$54.60	96
New York	2,010	$79.71	$52.27	59
Texas	1,897	$74.08	$56.26	50
Arizona	1,729	$71.74	$53.40	38
Pennsylvania	1,690	$75.66	$55.33	51
South Carolina	1,395	$71.64	$55.76	23
Virginia	1,332	$77.78	$55.71	31
New Jersey	1,175	$88.72	$59.13	37
Massachusetts	1,133	$77.62	$54.45	21
Maryland	951	$73.87	$52.34	24
Minnesota	892	$70.40	$51.91	29
Illinois	862	$76.44	$55.87	28
Mississippi	855	$73.33	$60.48	14
Michigan	728	$80.00	$57.41	20
Utah	638	$66.73	$44.44	17
Tennessee	635	$64.89	$53.59	17
Wisconsin	624	$64.90	$49.50	18
Indiana	602	$73.75	$58.56	15
Oregon	595	$68.68	$49.32	10
North Carolina	539	$76.61	$55.87	17
Georgia	517	$76.21	$59.10	17
Colorado	482	$80.78	$56.43	14
Missouri	467	$66.88	$52.16	18
Ohio	445	$67.42	$50.27	14
Iowa	429	$65.82	$50.76	12
Oklahoma	411	$65.68	$51.32	9
South Dakota	384	$79.86	$59.51	9
New Hampshire	381	$69.45	$47.91	6
Montana	380	$68.65	$44.88	4
Connecticut	352	$79.80	$54.60	12
Washington	352	$75.67	$51.58	11
Delaware	339	$84.62	$65.36	5
Nevada	324	$72.23	$54.71	8
Rhode Island	273	$77.78	$56.08	9
Idaho	226	$57.63	$46.66	7
Arkansas	222	$67.99	$53.36	6
Alabama	194	$62.55	$50.43	5
Louisiana	193	$67.94	$54.42	6
Kansas	185	$69.53	$56.92	6
Kentucky	147	$68.38	$54.55	5
New Mexico	142	$80.58	$62.16	5
Alaska	79	$93.32	$54.11	3
Maine	51	$73.69	$53.69	2
North Dakota	42	$50.03	$38.46	2
Nebraska	35	$79.30	$65.39	2
District of Columbia	31	$103.42	$69.99	2
West Virginia	25	$56.29	$42.46	2
Wyoming	20	$75.88	$62.62	1

Related codes

20610Aspiration and/or injection of fluid from large joint$65.03
20611Aspiration and/or injection of fluid large joint$101.93
20600Aspiration and/or injection of fluid from small joint$47.60
20605Aspiration and/or injection of fluid from medium joint$50.73
20606Aspiration and/or injection of fluid from medium joint$85.99
20680Removal of deep implant from bone$686.12
20612Aspiration and/or injection of cyst of tendon$59.89

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.