How much does Medicare pay for CPT 49180?

Medicare allowed an average of $82.70 per service and paid $64.43 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $718.29, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 49180?

Needle biopsy of growth of abdominal cavity. It was billed 4,348 times to 4,282 Medicare beneficiaries by 277 providers in 2024.

Does 49180 pay differently in an office than a hospital?

Yes. The allowed amount averaged $102.46 in an office setting and $80.35 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 49180 most?

Diagnostic Radiology, with 2,795 services from 178 clinicians. Next are Interventional Radiology, Ambulatory Surgical Center, Physician Assistant.

CPT 49180

Needle biopsy of growth of abdominal cavity

$82.70Medicare-allowed amount per service, averaged across 4,348 services

Providers submitted

$718.29

Asking price, not received

Medicare allowed

$82.70

The fee schedule figure

Medicare paid

$64.43

Balance is patient coinsurance

Providers submitted an average of $718.29 for this code and Medicare allowed $82.70 — 8.7× 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 $64.43 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $102.46
Hospital / facility: $80.35

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. 462 services were billed in an office setting and 3,886 in a facility.

Services: 4,348
Beneficiaries: 4,282
Providers billing it: 277
Total allowed: $359,580

What Medicare pays for CPT 49180

Across 4,348 services billed by 277 providers to 4,282 beneficiaries, Medicare allowed an average of $82.70 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 49180

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	2,795	2,747	$79.52	178
Interventional Radiology	1,429	1,414	$79.68	90
Ambulatory Surgical Center	28	27	$590.16	2
Physician Assistant	26	26	$61.97	2
Interventional Cardiology	23	21	$79.47	1
Internal Medicine	13	13	$79.46	1
Undefined Physician type	12	12	$71.47	1
Nuclear Medicine	11	11	$78.32	1
Nurse Practitioner	11	11	$66.09	1

49180 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
Texas	521	$91.31	$71.53	29
Florida	461	$82.05	$60.60	29
New York	373	$83.22	$58.05	25
California	313	$77.69	$55.93	18
Massachusetts	308	$80.53	$58.84	20
Minnesota	189	$75.61	$57.26	12
Iowa	180	$71.16	$59.05	10
Arizona	161	$74.07	$58.71	11
Pennsylvania	144	$78.37	$60.00	10
Virginia	142	$73.60	$57.79	11
Ohio	132	$75.45	$57.82	8
Maryland	127	$79.58	$57.76	8
Tennessee	122	$131.63	$106.27	5
Illinois	112	$78.55	$56.56	8
Kansas	111	$72.16	$58.15	6
Missouri	99	$77.57	$61.56	7
Nebraska	81	$66.99	$55.52	5
Washington	68	$73.01	$57.53	5
Georgia	67	$78.61	$58.10	5
New Jersey	62	$79.42	$57.33	4
Arkansas	57	$228.71	$196.48	4
Oklahoma	52	$73.85	$58.01	4
Utah	36	$78.41	$60.43	3
West Virginia	35	$72.08	$54.89	2
Mississippi	32	$70.54	$58.07	2
Delaware	31	$77.70	$59.80	2
District of Columbia	31	$80.74	$57.77	2
New Hampshire	29	$70.74	$56.37	2
Oregon	29	$75.73	$56.63	2
Rhode Island	29	$80.62	$56.37	2
Michigan	27	$81.72	$59.50	2
South Dakota	27	$70.16	$52.63	2
Indiana	26	$73.46	$59.31	2
North Carolina	23	$71.94	$56.29	2
Wisconsin	20	$70.64	$58.05	1
Alabama	18	$73.05	$59.50	1
Kentucky	13	$76.08	$62.99	1
South Carolina	13	$71.87	$55.83	1
Connecticut	13	$77.73	$63.00	1
Vermont	12	$88.79	$57.24	1
Louisiana	11	$78.19	$62.87	1
Idaho	11	$75.15	$63.07	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.