How much does Medicare pay for CPT 37243?

Medicare allowed an average of $4293.10 per service and paid $3422.99 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $19,547, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 37243?

Occlusion of growths or obstructed vessels with review by radiologist. It was billed 10,658 times to 9,522 Medicare beneficiaries by 322 providers in 2024.

Does 37243 pay differently in an office than a hospital?

Yes. The allowed amount averaged $8194.45 in an office setting and $545.34 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 37243 most?

Interventional Radiology, with 5,429 services from 149 clinicians. Next are Diagnostic Radiology, Urology, Interventional Cardiology.

CPT 37243

Occlusion of growths or obstructed vessels with review by radiologist

$4293.10Medicare-allowed amount per service, averaged across 10,658 services

Providers submitted

$19,547

Asking price, not received

Medicare allowed

$4293.10

The fee schedule figure

Medicare paid

$3422.99

Balance is patient coinsurance

Providers submitted an average of $19,547 for this code and Medicare allowed $4293.10 — 4.6× 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 $3422.99 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $8194.45
Hospital / facility: $545.34

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. 5,222 services were billed in an office setting and 5,436 in a facility.

Services: 10,658
Beneficiaries: 9,522
Providers billing it: 322
Total allowed: $45,755,860

What Medicare pays for CPT 37243

Across 10,658 services billed by 322 providers to 9,522 beneficiaries, Medicare allowed an average of $4293.10 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 37243

Specialty	Services	Beneficiaries	Avg allowed	Providers
Interventional Radiology	5,429	4,892	$4617.13	149
Diagnostic Radiology	5,080	4,493	$3908.48	168
Urology	68	68	$618.10	2
Interventional Cardiology	57	50	$9782.66	2
Cardiology	24	19	$9780.24	1

37243 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
New York	1,040	$5860.42	$4187.37	22
California	940	$1434.08	$1017.46	34
Florida	851	$2346.46	$1876.15	29
Virginia	648	$6634.36	$4558.75	12
Texas	626	$5429.80	$4407.36	20
Maryland	608	$5220.34	$3840.55	12
North Carolina	559	$5522.66	$4782.46	11
Arizona	549	$6984.74	$5720.46	11
Pennsylvania	539	$550.98	$414.53	19
Massachusetts	487	$6260.54	$4412.84	12
Missouri	391	$6039.50	$5044.61	6
Michigan	357	$7494.64	$5909.63	7
Illinois	340	$4701.20	$3641.95	14
Tennessee	313	$3970.48	$3497.59	13
Colorado	187	$5634.71	$4271.95	5
Mississippi	184	$4463.13	$3401.32	6
Georgia	150	$2063.15	$1611.08	6
Oregon	149	$536.36	$421.18	6
Ohio	147	$3868.09	$3344.01	7
Washington	131	$2881.58	$2241.35	8
Iowa	127	$4221.09	$3511.40	3
Alabama	123	$3677.62	$3306.52	5
Minnesota	120	$2959.55	$2313.47	4
Indiana	114	$4846.11	$4182.97	5
South Carolina	113	$517.19	$417.52	7
Kentucky	87	$7266.74	$6557.49	1
Kansas	85	$1468.47	$1266.53	3
Wisconsin	82	$3205.00	$2587.61	4
New Jersey	73	$574.52	$423.20	4
South Dakota	70	$6065.40	$4754.68	2
Louisiana	69	$526.53	$419.58	3
Arkansas	64	$1726.98	$1688.72	3
Connecticut	58	$551.65	$416.13	3
Utah	57	$508.00	$408.77	2
District of Columbia	53	$566.44	$416.98	3
Delaware	48	$528.72	$425.50	3
Oklahoma	47	$4440.00	$3923.19	2
Nebraska	31	$486.76	$414.11	2
New Mexico	19	$7712.56	$6546.22	1
North Dakota	11	$511.62	$423.07	1
Alaska	11	$712.90	$421.82	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
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
37242Occlusion of artery$4565.89
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.