How much does Medicare pay for CPT 36430?

Medicare allowed an average of $42.77 per service and paid $33.88 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $174.59, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 36430?

Transfusion of blood or blood products. It was billed 2,855 times to 1,408 Medicare beneficiaries by 65 providers in 2024.

Which specialty bills 36430 most?

Hematology-Oncology, with 1,609 services from 30 clinicians. Next are Medical Oncology, Nurse Practitioner, Hospitalist.

CPT 36430

Transfusion of blood or blood products

$42.77Medicare-allowed amount per service, averaged across 2,855 services

Providers submitted

$174.59

Asking price, not received

Medicare allowed

$42.77

The fee schedule figure

Medicare paid

$33.88

Balance is patient coinsurance

Providers submitted an average of $174.59 for this code and Medicare allowed $42.77 — 4.1× 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 $33.88 (79%); the rest is the patient’s coinsurance and deductible.

Services: 2,855
Beneficiaries: 1,408
Providers billing it: 65
Total allowed: $122,108

What Medicare pays for CPT 36430

Across 2,855 services billed by 65 providers to 1,408 beneficiaries, Medicare allowed an average of $42.77 per service. That is 2.0 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 36430

Specialty	Services	Beneficiaries	Avg allowed	Providers
Hematology-Oncology	1,609	745	$43.40	30
Medical Oncology	741	382	$40.94	20
Nurse Practitioner	176	109	$39.19	4
Hospitalist	85	34	$48.81	1
Pediatric Medicine	83	37	$50.51	3
Hematology	80	40	$44.46	3
Physician Assistant	34	30	$35.52	2
Family Practice	25	19	$44.02	1
Hospice and Palliative Care	22	12	$38.06	1

36430 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	616	$39.23	$33.14	11
Missouri	524	$39.34	$32.83	16
Maryland	515	$43.48	$33.02	8
California	496	$49.13	$32.56	11
New York	210	$48.58	$31.52	7
Minnesota	168	$37.09	$27.82	5
Connecticut	165	$46.85	$32.63	4
Ohio	96	$37.91	$32.12	1
Illinois	45	$40.00	$32.81	1
Rhode Island	20	$48.85	$33.09	1

Related codes

36415Insertion of needle into vein for collection of blood sample$8.49
36465Injection of chemical agent into single incompetent vein of leg$1256.40
36410Insertion of needle into vein (3 years or older)$16.89
36471Injection of chemical agent into multiple incompetent veins of leg$187.64
36475Destruction of first incompetent vein of arm or leg$1015.19
36482Chemical destruction of first incompetent vein of arm or leg$1603.82
36478Laser destruction of incompetent vein of arm or leg$907.22
36466Injection of chemical agent into multiple incompetent veins of same le$1330.00
36470Injection of chemical agent into single incompetent vein$103.15
36479Laser destruction of incompetent veins of arm or leg$285.92
36476Destruction of subsequent incompetent veins of arm or leg$268.55

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.