How much does Medicare pay for CPT 37242?

Medicare allowed an average of $4565.89 per service and paid $3640.65 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $19,346, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 37242?

Occlusion of artery with review by radiologist. It was billed 6,179 times to 5,035 Medicare beneficiaries by 119 providers in 2024.

Does 37242 pay differently in an office than a hospital?

Yes. The allowed amount averaged $4824.49 in an office setting and $3292.47 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 37242 most?

Interventional Radiology, with 2,731 services from 43 clinicians. Next are Diagnostic Radiology, Vascular Surgery, Ambulatory Surgical Center.

CPT 37242

Occlusion of artery with review by radiologist

$4565.89Medicare-allowed amount per service, averaged across 6,179 services

Providers submitted

$19,346

Asking price, not received

Medicare allowed

$4565.89

The fee schedule figure

Medicare paid

$3640.65

Balance is patient coinsurance

Providers submitted an average of $19,346 for this code and Medicare allowed $4565.89 — 4.2× 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 $3640.65 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $4824.49
Hospital / facility: $3292.47

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. 5,136 services were billed in an office setting and 1,043 in a facility.

Services: 6,179
Beneficiaries: 5,035
Providers billing it: 119
Total allowed: $28,212,634

What Medicare pays for CPT 37242

Across 6,179 services billed by 119 providers to 5,035 beneficiaries, Medicare allowed an average of $4565.89 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 37242

Specialty	Services	Beneficiaries	Avg allowed	Providers
Interventional Radiology	2,731	2,378	$4046.75	43
Diagnostic Radiology	2,451	2,001	$4514.91	47
Vascular Surgery	433	315	$3645.54	18
Ambulatory Surgical Center	337	168	$9378.76	7
Interventional Cardiology	154	112	$5875.34	3
General Surgery	73	61	$6177.26	1

37242 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
Virginia	619	$4973.20	$3538.18	9
Arizona	593	$4487.46	$3697.25	14
Texas	548	$5004.84	$3980.94	11
New York	497	$4338.02	$3143.97	9
California	477	$4427.93	$3313.82	7
Maryland	386	$3904.72	$2896.20	3
Michigan	371	$4070.16	$3389.18	6
Massachusetts	368	$4338.69	$3114.46	4
Missouri	319	$3496.12	$2965.26	2
Florida	205	$4957.19	$4172.16	3
New Jersey	194	$6166.45	$4401.98	3
North Carolina	159	$4995.99	$4387.09	3
Illinois	159	$3332.11	$1924.29	3
District of Columbia	150	$6355.63	$4253.65	2
Indiana	149	$5062.65	$4335.84	5
Ohio	134	$4969.27	$4364.67	4
Kentucky	113	$3185.10	$2863.63	3
Mississippi	101	$4091.05	$3376.74	2
South Dakota	98	$5946.68	$4483.13	2
Georgia	82	$6268.04	$4773.22	3
Delaware	82	$6761.84	$5390.75	2
Tennessee	47	$4918.38	$4363.52	3
New Mexico	44	$6323.74	$5408.21	2
Oregon	41	$4702.99	$3805.45	2
Oklahoma	40	$5702.50	$4813.07	2
Kansas	36	$430.28	$347.90	2
Colorado	33	$4730.61	$3693.96	2
South Carolina	30	$269.11	$222.44	1
Iowa	28	$3421.97	$2898.91	1
Wisconsin	25	$3369.51	$2705.64	1
Pennsylvania	20	$271.80	$197.32	1
Connecticut	16	$395.26	$270.15	1
Minnesota	15	$6455.92	$5495.64	1

Related codes

37253Ultrasound evaluation of blood vessel$158.74
37252Ultrasound evaluation of blood vessel$758.72
37229Removal of plaque in artery of leg$7260.85
37225Removal of plaque in arteries of leg$5516.77
37243Occlusion of growths or obstructed vessels$4293.10
37227Removal of plaque and insertion of stents in arteries of leg$9119.72
37228Balloon dilation of artery of leg$1158.26
37224Balloon dilation of artery of leg$562.15
37215Insertion of stent and blood clot protection device in neck artery$885.92
37248Balloon dilation of vein$1242.61
37238Insertion of stent in vein$2975.98
37233Removal of plaque in artery of leg$1004.57

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.