How much does Medicare pay for CPT 25000?

Medicare allowed an average of $377.65 per service and paid $298.58 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $3841.90, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 25000?

Incision or the tendon covering on the top side of the wrist. It was billed 3,366 times to 3,268 Medicare beneficiaries by 196 providers in 2024.

Does 25000 pay differently in an office than a hospital?

Yes. The allowed amount averaged $233.94 in an office setting and $382.14 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 25000 most?

Ambulatory Surgical Center, with 1,618 services from 94 clinicians. Next are Hand Surgery, Orthopedic Surgery, Plastic and Reconstructive Surgery.

CPT 25000

Incision or the tendon covering on the top side of the wrist

$377.65Medicare-allowed amount per service, averaged across 3,366 services

Providers submitted

$3841.90

Asking price, not received

Medicare allowed

$377.65

The fee schedule figure

Medicare paid

$298.58

Balance is patient coinsurance

Providers submitted an average of $3841.90 for this code and Medicare allowed $377.65 — 10.2× 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 $298.58 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $233.94
Hospital / facility: $382.14

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 102 services were billed in an office setting and 3,264 in a facility.

Services: 3,366
Beneficiaries: 3,268
Providers billing it: 196
Total allowed: $1,271,170

What Medicare pays for CPT 25000

Across 3,366 services billed by 196 providers to 3,268 beneficiaries, Medicare allowed an average of $377.65 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 25000

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	1,618	1,575	$554.60	94
Hand Surgery	1,247	1,206	$217.58	73
Orthopedic Surgery	459	447	$202.78	26
Plastic and Reconstructive Surgery	27	26	$235.25	2
General Surgery	15	14	$205.58	1

25000 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	452	$407.18	$336.07	27
Pennsylvania	387	$304.22	$250.62	21
Texas	227	$268.33	$219.46	10
California	210	$360.61	$249.44	12
South Carolina	203	$312.53	$268.42	11
North Carolina	159	$383.65	$323.75	7
Illinois	146	$483.23	$379.26	10
Virginia	130	$401.30	$340.30	8
Arizona	121	$494.28	$397.37	8
Tennessee	116	$297.37	$264.21	6
Massachusetts	115	$309.98	$227.29	7
Maryland	111	$428.25	$352.59	6
Colorado	97	$416.12	$328.41	6
New York	86	$481.30	$356.19	5
Ohio	84	$327.25	$281.07	5
Nebraska	75	$233.88	$195.28	4
Georgia	62	$421.35	$366.83	4
New Jersey	60	$556.01	$414.89	5
Connecticut	54	$434.38	$316.60	4
Delaware	47	$473.31	$378.29	3
Alabama	46	$314.58	$293.44	3
Mississippi	40	$499.61	$438.19	3
Arkansas	37	$440.58	$377.34	2
Wisconsin	36	$338.70	$275.78	2
Rhode Island	33	$441.82	$363.92	2
Louisiana	28	$392.37	$354.03	2
Oklahoma	28	$170.37	$151.48	1
Kentucky	23	$342.01	$288.83	2
Iowa	21	$664.47	$542.00	1
Guam	21	$245.60	$173.90	1
New Hampshire	16	$648.16	$521.58	1
Montana	15	$621.93	$545.75	1
Alaska	14	$478.70	$372.63	1
Indiana	14	$648.24	$522.84	1
Michigan	14	$629.56	$506.17	1
Nevada	14	$418.00	$343.96	1
Idaho	12	$158.76	$138.97	1
Utah	12	$319.03	$255.92	1

Related codes

25020Incision of tissue of forearm and/or wrist muscle compartment on one s$704.69

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.