How much does Medicare pay for CPT 56820?

Medicare allowed an average of $118.17 per service and paid $87.54 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $417.49, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 56820?

Exam of external female genitals using an endoscope. It was billed 3,244 times to 2,467 Medicare beneficiaries by 92 providers in 2024.

Does 56820 pay differently in an office than a hospital?

Yes. The allowed amount averaged $121.41 in an office setting and $76.18 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 56820 most?

Obstetrics & Gynecology, with 1,775 services from 38 clinicians. Next are Gynecological Oncology, Nurse Practitioner, Urology.

CPT 56820

Exam of external female genitals using an endoscope

$118.17Medicare-allowed amount per service, averaged across 3,244 services

Providers submitted

$417.49

Asking price, not received

Medicare allowed

$118.17

The fee schedule figure

Medicare paid

$87.54

Balance is patient coinsurance

Providers submitted an average of $417.49 for this code and Medicare allowed $118.17 — 3.5× 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 $87.54 (74%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $121.41
Hospital / facility: $76.18

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. 3,012 services were billed in an office setting and 232 in a facility.

Services: 3,244
Beneficiaries: 2,467
Providers billing it: 92
Total allowed: $383,343

What Medicare pays for CPT 56820

Across 3,244 services billed by 92 providers to 2,467 beneficiaries, Medicare allowed an average of $118.17 per service. That is 1.3 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 56820

Specialty	Services	Beneficiaries	Avg allowed	Providers
Obstetrics & Gynecology	1,775	1,371	$124.05	38
Gynecological Oncology	967	712	$109.24	36
Nurse Practitioner	192	153	$107.40	9
Urology	169	114	$134.14	2
Physician Assistant	63	50	$98.77	3
Family Practice	47	41	$111.86	2
Certified Nurse Midwife	18	15	$84.54	1
Certified Clinical Nurse Specialist	13	11	$94.29	1

56820 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	873	$136.11	$86.87	14
Florida	469	$121.68	$85.40	9
California	381	$118.21	$82.34	4
Tennessee	232	$93.52	$79.28	4
Oklahoma	115	$112.45	$86.80	6
Texas	113	$99.64	$74.82	6
New Jersey	100	$136.68	$90.18	4
Missouri	83	$92.97	$68.87	4
Minnesota	75	$109.13	$82.83	3
Iowa	72	$100.54	$76.25	4
Illinois	62	$116.23	$79.29	3
Virginia	60	$130.16	$80.80	3
Pennsylvania	59	$104.29	$79.28	3
Maryland	54	$126.35	$90.63	2
Louisiana	50	$116.26	$84.89	2
Michigan	50	$114.24	$85.73	3
Massachusetts	46	$71.75	$52.52	2
Kentucky	41	$91.12	$77.71	2
Vermont	40	$121.48	$84.69	1
Arizona	35	$121.09	$87.90	2
Mississippi	30	$69.05	$59.04	1
Wisconsin	27	$113.68	$80.60	1
Montana	23	$123.54	$93.23	1
Colorado	23	$127.46	$80.71	1
Washington	21	$102.63	$73.41	1
South Carolina	21	$117.91	$88.01	1
Nebraska	20	$99.14	$73.35	1
Ohio	19	$78.23	$60.51	1
Georgia	18	$117.34	$89.58	1
North Carolina	17	$75.57	$56.43	1
Arkansas	15	$110.56	$94.24	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.