How much does Medicare pay for CPT 30469?

Medicare allowed an average of $1973.16 per service and paid $1572.15 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $5382.19, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 30469?

Repair of collapsed nasal valve. It was billed 2,522 times to 2,507 Medicare beneficiaries by 99 providers in 2024.

Does 30469 pay differently in an office than a hospital?

Yes. The allowed amount averaged $2009.68 in an office setting and $592.82 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 30469 most?

Otolaryngology, with 2,511 services from 98 clinicians. Next are Ambulatory Surgical Center.

CPT 30469

Repair of collapsed nasal valve

$1973.16Medicare-allowed amount per service, averaged across 2,522 services

Providers submitted

$5382.19

Asking price, not received

Medicare allowed

$1973.16

The fee schedule figure

Medicare paid

$1572.15

Balance is patient coinsurance

Providers submitted an average of $5382.19 for this code and Medicare allowed $1973.16 — 2.7× 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 $1572.15 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $2009.68
Hospital / facility: $592.82

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. 2,457 services were billed in an office setting and 65 in a facility.

Services: 2,522
Beneficiaries: 2,507
Providers billing it: 99
Total allowed: $4,976,310

What Medicare pays for CPT 30469

Across 2,522 services billed by 99 providers to 2,507 beneficiaries, Medicare allowed an average of $1973.16 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 30469

Specialty	Services	Beneficiaries	Avg allowed	Providers
Otolaryngology	2,511	2,496	$1968.19	98
Ambulatory Surgical Center	11	11	$3108.27	1

30469 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	384	$1597.91	$1287.70	15
California	294	$2184.97	$1513.47	14
Arizona	264	$2316.36	$1817.98	6
Illinois	225	$1486.98	$1173.65	3
Florida	206	$2128.82	$1681.32	12
Michigan	158	$2486.04	$1898.15	2
New York	127	$2003.24	$1365.65	6
South Carolina	105	$2059.73	$1732.30	4
Pennsylvania	92	$2291.66	$1790.88	5
Missouri	92	$1332.90	$1161.55	2
Kentucky	87	$2125.52	$1895.67	1
New Jersey	69	$2614.54	$1762.50	4
Alabama	64	$2056.92	$1904.16	4
Washington	59	$1858.79	$1296.08	2
Tennessee	42	$1336.97	$1149.83	3
Georgia	41	$1220.77	$1091.90	2
North Carolina	37	$1752.78	$1404.92	2
Mississippi	32	$2045.41	$1901.86	2
Louisiana	29	$2171.63	$1858.98	2
Iowa	26	$2114.96	$1898.31	2
Utah	18	$1538.24	$1302.98	1
Kansas	16	$2154.05	$1904.88	1
Hawaii	15	$2754.91	$1902.93	1
Maryland	14	$1301.91	$1021.30	1
Arkansas	14	$2117.73	$1881.46	1
Nebraska	12	$2192.06	$1891.30	1

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.