How much does Medicare pay for CPT 20612?

Medicare allowed an average of $59.89 per service and paid $44.36 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $224.25, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 20612?

Aspiration and/or injection of cyst of tendon. It was billed 4,664 times to 3,764 Medicare beneficiaries by 206 providers in 2024.

Does 20612 pay differently in an office than a hospital?

Yes. The allowed amount averaged $60.12 in an office setting and $41.80 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 20612 most?

Hand Surgery, with 2,001 services from 94 clinicians. Next are Orthopedic Surgery, Podiatry, Plastic and Reconstructive Surgery.

CPT 20612

Aspiration and/or injection of cyst of tendon

$59.89Medicare-allowed amount per service, averaged across 4,664 services

Providers submitted

$224.25

Asking price, not received

Medicare allowed

$59.89

The fee schedule figure

Medicare paid

$44.36

Balance is patient coinsurance

Providers submitted an average of $224.25 for this code and Medicare allowed $59.89 — 3.7× 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 $44.36 (74%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $60.12
Hospital / facility: $41.80

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. 4,606 services were billed in an office setting and 58 in a facility.

Services: 4,664
Beneficiaries: 3,764
Providers billing it: 206
Total allowed: $279,327

What Medicare pays for CPT 20612

Across 4,664 services billed by 206 providers to 3,764 beneficiaries, Medicare allowed an average of $59.89 per service. That is 1.2 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 20612

Specialty	Services	Beneficiaries	Avg allowed	Providers
Hand Surgery	2,001	1,782	$64.60	94
Orthopedic Surgery	1,446	1,271	$63.82	80
Podiatry	861	391	$43.48	12
Plastic and Reconstructive Surgery	107	98	$63.94	5
Physician Assistant	106	96	$50.18	7
Physical Medicine and Rehabilitation	52	45	$59.44	3
General Surgery	47	43	$58.67	2
Nurse Practitioner	24	22	$48.50	2
Family Practice	20	16	$59.46	1

20612 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
New York	1,044	$53.12	$36.02	26
California	644	$68.17	$45.20	28
Florida	538	$62.45	$44.56	20
Texas	514	$60.57	$45.73	22
New Jersey	216	$70.88	$47.93	13
Pennsylvania	181	$60.11	$45.19	10
Virginia	143	$57.90	$43.23	9
Arizona	129	$48.85	$35.98	6
Illinois	119	$56.77	$38.03	6
Maryland	112	$65.62	$46.33	7
Georgia	97	$57.02	$40.61	5
North Carolina	80	$58.73	$47.03	4
Louisiana	70	$57.33	$46.71	4
Massachusetts	68	$66.42	$46.75	5
Tennessee	66	$56.85	$45.28	4
Ohio	64	$57.16	$43.33	4
Nevada	56	$59.42	$45.95	3
Mississippi	54	$55.39	$45.97	2
Kentucky	51	$57.48	$47.70	3
Michigan	41	$64.43	$39.49	2
Indiana	39	$56.64	$44.25	3
Oregon	37	$57.54	$44.22	1
Missouri	36	$60.83	$47.09	2
Hawaii	33	$67.88	$48.70	1
Delaware	29	$61.62	$43.13	2
Iowa	29	$52.65	$41.78	2
Alabama	28	$56.76	$45.38	2
Nebraska	28	$51.51	$40.18	2
Connecticut	28	$66.30	$47.86	2
New Hampshire	22	$65.57	$46.95	1
New Mexico	16	$40.49	$24.19	1
Kansas	16	$56.94	$50.22	1
District of Columbia	13	$69.12	$39.22	1
Colorado	12	$63.00	$48.64	1
Minnesota	11	$63.04	$48.82	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
20604Aspiration and/or injection of fluid from small joint$75.96
20606Aspiration and/or injection of fluid from medium joint$85.99
20680Removal of deep implant from bone$686.12

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.