How much does Medicare pay for CPT 27096?

Medicare allowed an average of $149.42 per service and paid $113.87 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $970.30, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 27096?

Injection of anesthetic or steroid into joint between lower spine and hip bone using imaging guidance. It was billed 270,317 times to 202,602 Medicare beneficiaries by 5,479 providers in 2024.

Does 27096 pay differently in an office than a hospital?

Yes. The allowed amount averaged $185.91 in an office setting and $98.22 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 27096 most?

Pain Management, with 81,387 services from 1,496 clinicians. Next are Physical Medicine and Rehabilitation, Anesthesiology, Interventional Pain Management.

CPT 27096

Injection of anesthetic or steroid into joint between lower spine and hip bone using imaging guidance

$149.42Medicare-allowed amount per service, averaged across 270,317 services

Providers submitted

$970.30

Asking price, not received

Medicare allowed

$149.42

The fee schedule figure

Medicare paid

$113.87

Balance is patient coinsurance

Providers submitted an average of $970.30 for this code and Medicare allowed $149.42 — 6.5× 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 $113.87 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $185.91
Hospital / facility: $98.22

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. 157,842 services were billed in an office setting and 112,475 in a facility.

Services: 270,317
Beneficiaries: 202,602
Providers billing it: 5,479
Total allowed: $40,390,766

What Medicare pays for CPT 27096

Across 270,317 services billed by 5,479 providers to 202,602 beneficiaries, Medicare allowed an average of $149.42 per service. That is 1.3 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 27096

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pain Management	81,387	60,472	$149.06	1,496
Physical Medicine and Rehabilitation	61,281	47,456	$152.06	1,403
Anesthesiology	58,774	43,865	$142.87	1,189
Interventional Pain Management	46,881	34,122	$155.13	800
Orthopedic Surgery	4,443	3,325	$148.87	120
Diagnostic Radiology	3,392	2,903	$135.16	119
Neurology	1,972	1,413	$161.33	42
Physician Assistant	1,870	1,485	$148.45	55
Family Practice	1,614	1,139	$170.96	32
Neurosurgery	1,590	1,145	$130.32	49
Nurse Practitioner	1,459	1,032	$138.72	32
Internal Medicine	1,334	851	$207.32	24
Certified Registered Nurse Anesthetist (CRNA)	867	673	$115.77	23
Sports Medicine	734	604	$161.29	23
Interventional Radiology	561	456	$143.19	19

27096 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	30,053	$171.60	$131.98	538
California	20,550	$149.93	$106.93	392
Texas	18,396	$146.67	$116.21	436
Pennsylvania	11,509	$133.41	$102.80	254
North Carolina	11,230	$165.35	$133.14	198
Arizona	10,336	$162.13	$127.36	172
Illinois	10,255	$163.09	$124.75	192
New York	10,247	$177.18	$124.56	244
Ohio	9,886	$122.64	$96.29	207
Georgia	9,224	$121.20	$96.62	191
Virginia	9,050	$180.50	$136.98	144
South Carolina	8,165	$165.38	$135.11	122
Michigan	7,393	$170.38	$133.28	167
Missouri	6,633	$121.82	$95.83	114
Kentucky	6,386	$152.82	$126.42	93
Massachusetts	6,133	$144.27	$104.63	143
Indiana	5,755	$131.12	$106.72	133
New Jersey	4,649	$175.12	$124.09	121
Maryland	4,583	$133.77	$99.61	108
Colorado	4,543	$142.99	$107.49	102
Wisconsin	4,444	$118.33	$93.91	113
Oklahoma	4,409	$144.36	$120.60	73
Alabama	4,246	$137.03	$119.16	74
Tennessee	4,085	$142.90	$119.99	90
Washington	3,648	$141.27	$104.16	98
Utah	3,584	$172.07	$135.60	72
Minnesota	3,400	$115.07	$89.35	111
Arkansas	3,288	$135.83	$114.21	60
Louisiana	3,095	$119.04	$96.96	75
Mississippi	3,001	$109.75	$91.64	46
Kansas	2,956	$105.40	$86.34	62
Iowa	2,795	$138.83	$113.16	45
Oregon	2,472	$137.96	$107.52	59
Nebraska	2,297	$158.59	$132.44	41
Connecticut	2,045	$161.31	$115.76	56
Nevada	1,863	$170.76	$132.16	40
Idaho	1,650	$98.70	$80.44	35
South Dakota	1,646	$104.76	$81.35	27
West Virginia	1,497	$113.85	$89.36	27
New Hampshire	1,394	$134.84	$103.31	34
North Dakota	1,313	$102.06	$79.50	24
Delaware	1,024	$142.35	$110.72	24
New Mexico	995	$145.47	$116.30	29
Maine	917	$160.79	$122.54	13
Montana	838	$119.30	$88.27	18
Alaska	737	$218.74	$140.18	14
Rhode Island	663	$143.61	$107.71	18
Wyoming	345	$144.88	$112.06	7
Vermont	282	$127.62	$88.57	9
District of Columbia	251	$182.33	$125.31	9
Puerto Rico	88	$148.86	$118.64	3
Hawaii	73	$132.37	$110.82	2

Related codes

27093Injection of contrast for imaging of hip joint$216.38
27095Injection of contrast for imaging of hip under anesthesia$162.03

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.