How much does Medicare pay for CPT 52442?

Medicare allowed an average of $313.72 per service and paid $250.65 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1912.25, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 52442?

Insertion of implant in urethra within prostate gland using an endoscope, each additional implant. It was billed 29,681 times to 6,963 Medicare beneficiaries by 357 providers in 2024.

Does 52442 pay differently in an office than a hospital?

Yes. The allowed amount averaged $883.44 in an office setting and $48.92 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 52442 most?

Urology, with 29,555 services from 356 clinicians. Next are Osteopathic Manipulative Medicine.

CPT 52442

Insertion of implant in urethra within prostate gland using an endoscope, each additional implant

$313.72Medicare-allowed amount per service, averaged across 29,681 services

Providers submitted

$1912.25

Asking price, not received

Medicare allowed

$313.72

The fee schedule figure

Medicare paid

$250.65

Balance is patient coinsurance

Providers submitted an average of $1912.25 for this code and Medicare allowed $313.72 — 6.1× 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 $250.65 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $883.44
Hospital / facility: $48.92

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. 9,418 services were billed in an office setting and 20,263 in a facility.

Services: 29,681
Beneficiaries: 6,963
Providers billing it: 357
Total allowed: $9,311,523

What Medicare pays for CPT 52442

Across 29,681 services billed by 357 providers to 6,963 beneficiaries, Medicare allowed an average of $313.72 per service. That is 4.3 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 52442

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	29,555	6,938	$314.87	356
Osteopathic Manipulative Medicine	126	25	$43.19	1

52442 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	3,166	$752.74	$489.63	29
Florida	3,066	$127.14	$101.92	37
New Jersey	1,822	$585.07	$418.24	13
Arizona	1,594	$462.07	$382.65	19
Maryland	1,530	$51.47	$38.80	19
Texas	1,441	$401.46	$330.23	19
Georgia	1,259	$133.95	$112.96	22
New York	1,213	$724.76	$491.88	10
Virginia	1,194	$48.31	$38.67	14
Ohio	1,189	$95.87	$82.85	15
Tennessee	1,180	$230.65	$196.87	16
Washington	1,044	$169.91	$124.82	13
Illinois	927	$489.65	$353.74	11
Michigan	812	$514.37	$445.89	7
South Carolina	743	$181.96	$147.73	11
Pennsylvania	728	$49.57	$38.77	11
North Carolina	688	$227.70	$185.73	8
Oregon	619	$419.30	$306.21	8
Indiana	590	$132.58	$117.29	5
Mississippi	489	$46.70	$38.71	7
Colorado	462	$149.85	$114.09	7
Missouri	438	$127.08	$110.87	6
Kansas	333	$47.44	$38.77	5
Arkansas	324	$44.74	$38.70	6
Oklahoma	321	$46.53	$38.74	4
Nebraska	311	$205.01	$186.18	5
Louisiana	227	$319.74	$273.81	3
Alabama	210	$46.67	$38.75	2
Idaho	198	$44.18	$37.30	2
Delaware	193	$50.87	$38.68	3
Iowa	184	$765.10	$668.21	3
Alaska	178	$873.33	$668.77	2
South Dakota	165	$45.20	$38.84	2
Massachusetts	159	$49.55	$37.81	2
Connecticut	119	$910.73	$663.68	1
New Hampshire	81	$877.12	$665.50	1
Wisconsin	74	$45.90	$38.34	1
District of Columbia	66	$57.09	$38.85	1
Maine	62	$47.50	$38.80	1
Kentucky	61	$48.91	$38.77	1
Montana	54	$48.66	$38.02	1
Utah	49	$47.53	$38.72	1
Hawaii	48	$48.60	$38.70	1
West Virginia	40	$48.26	$38.71	1
Vermont	30	$46.65	$36.27	1

Related codes

52441Insertion of implant in urethra within prostate gland$492.32

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.