How much does Medicare pay for CPT 43762?

Medicare allowed an average of $110.61 per service and paid $86.60 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $563.91, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 43762?

Replacement of stomach stoma tube. It was billed 4,854 times to 3,513 Medicare beneficiaries by 160 providers in 2024.

Does 43762 pay differently in an office than a hospital?

Yes. The allowed amount averaged $217.95 in an office setting and $31.20 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 43762 most?

Nurse Practitioner, with 1,682 services from 52 clinicians. Next are Physician Assistant, Gastroenterology, Internal Medicine.

CPT 43762

Replacement of stomach stoma tube

$110.61Medicare-allowed amount per service, averaged across 4,854 services

Providers submitted

$563.91

Asking price, not received

Medicare allowed

$110.61

The fee schedule figure

Medicare paid

$86.60

Balance is patient coinsurance

Providers submitted an average of $563.91 for this code and Medicare allowed $110.61 — 5.1× 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 $86.60 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $217.95
Hospital / facility: $31.20

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. 2,064 services were billed in an office setting and 2,790 in a facility.

Services: 4,854
Beneficiaries: 3,513
Providers billing it: 160
Total allowed: $536,901

What Medicare pays for CPT 43762

Across 4,854 services billed by 160 providers to 3,513 beneficiaries, Medicare allowed an average of $110.61 per service. That is 1.4 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 43762

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	1,682	1,249	$81.94	52
Physician Assistant	1,054	814	$138.95	34
Gastroenterology	905	599	$111.90	30
Internal Medicine	544	330	$131.57	12
General Surgery	213	150	$131.26	8
Interventional Radiology	149	140	$200.39	8
Emergency Medicine	109	98	$36.29	8
Certified Clinical Nurse Specialist	62	33	$28.89	1
Family Practice	60	41	$216.44	2
Diagnostic Radiology	29	24	$36.40	2
Pulmonary Disease	23	12	$20.21	1
Ambulatory Surgical Center	12	11	$106.83	1
General Practice	12	12	$35.88	1

43762 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
California	1,668	$118.76	$80.63	51
New York	881	$159.21	$108.13	23
Florida	390	$179.26	$139.62	15
Texas	251	$138.59	$106.41	11
Pennsylvania	193	$26.56	$21.56	6
Massachusetts	175	$83.96	$60.16	6
Wisconsin	154	$24.75	$19.98	5
South Carolina	154	$28.97	$22.81	1
New Jersey	145	$99.48	$67.36	5
Tennessee	135	$54.63	$45.93	5
Illinois	109	$68.73	$47.35	5
Mississippi	103	$58.46	$70.71	5
Ohio	95	$40.67	$30.83	3
Maryland	84	$152.20	$112.58	2
Kansas	77	$29.48	$23.10	5
Nevada	40	$28.05	$24.56	2
Kentucky	34	$31.07	$22.09	1
Connecticut	23	$218.80	$149.43	1
Minnesota	23	$28.23	$21.54	1
New Mexico	22	$32.74	$20.07	1
Virginia	22	$27.85	$22.37	1
Missouri	17	$26.69	$22.64	1
West Virginia	17	$34.11	$28.86	1
Michigan	16	$29.18	$19.52	1
Louisiana	13	$35.23	$28.82	1
North Carolina	13	$29.15	$24.62	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.