How much does Medicare pay for CPT 44213?

Medicare allowed an average of $161.54 per service and paid $129.02 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $999.45, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 44213?

Partial release of large bowel and partial removal of large bowel using an endoscope. It was billed 1,634 times to 1,630 Medicare beneficiaries by 106 providers in 2024.

Which specialty bills 44213 most?

Colorectal Surgery (Proctology), with 988 services from 62 clinicians. Next are General Surgery, Physician Assistant, Nurse Practitioner.

CPT 44213

Partial release of large bowel and partial removal of large bowel using an endoscope

$161.54Medicare-allowed amount per service, averaged across 1,634 services

Providers submitted

$999.45

Asking price, not received

Medicare allowed

$161.54

The fee schedule figure

Medicare paid

$129.02

Balance is patient coinsurance

Providers submitted an average of $999.45 for this code and Medicare allowed $161.54 — 6.2× 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 $129.02 (80%); the rest is the patient’s coinsurance and deductible.

Services: 1,634
Beneficiaries: 1,630
Providers billing it: 106
Total allowed: $263,956

What Medicare pays for CPT 44213

Across 1,634 services billed by 106 providers to 1,630 beneficiaries, Medicare allowed an average of $161.54 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 44213

Specialty	Services	Beneficiaries	Avg allowed	Providers
Colorectal Surgery (Proctology)	988	988	$182.79	62
General Surgery	440	436	$168.86	31
Physician Assistant	165	165	$26.44	10
Nurse Practitioner	17	17	$23.58	1
Vascular Surgery	12	12	$191.22	1
Surgical Oncology	12	12	$167.66	1

44213 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	170	$174.93	$115.62	8
Texas	159	$146.71	$118.91	10
California	136	$170.82	$131.71	10
Pennsylvania	122	$171.80	$132.18	8
Florida	108	$155.78	$112.21	6
Massachusetts	107	$173.01	$130.66	7
New Jersey	86	$148.29	$107.55	6
Oklahoma	71	$161.63	$134.95	5
North Carolina	69	$96.10	$88.25	4
Washington	64	$149.14	$122.86	4
Missouri	59	$133.38	$107.74	4
Georgia	51	$179.08	$143.25	3
Kansas	45	$169.82	$144.13	3
Ohio	41	$179.09	$143.34	3
Maryland	35	$200.34	$143.26	3
Virginia	32	$187.54	$143.21	2
South Carolina	30	$171.05	$143.57	2
Illinois	29	$186.20	$143.47	2
Arizona	28	$164.91	$134.40	2
District of Columbia	25	$123.08	$89.10	2
Indiana	25	$152.48	$139.93	2
South Dakota	19	$165.97	$143.68	1
Montana	17	$179.96	$143.80	1
Arkansas	16	$163.16	$143.21	1
Michigan	15	$180.51	$143.64	1
Maine	14	$168.74	$143.13	1
Kentucky	13	$176.82	$143.26	1
Colorado	12	$180.58	$143.60	1
Alabama	12	$120.60	$113.21	1
Nevada	12	$176.61	$143.59	1
Tennessee	12	$166.49	$143.40	1

Related codes

44207Partial removal of large bowel and reattachment to rectum$1484.09
44205Partial removal of small and large bowel$1151.42

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.