How much does Medicare pay for CPT 58100?

Medicare allowed an average of $94.81 per service and paid $70.98 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $357.17, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 58100?

Biopsy of lining of uterus. It was billed 4,714 times to 4,568 Medicare beneficiaries by 318 providers in 2024.

Does 58100 pay differently in an office than a hospital?

Yes. The allowed amount averaged $97.03 in an office setting and $60.05 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 58100 most?

Obstetrics & Gynecology, with 4,045 services from 271 clinicians. Next are Gynecological Oncology, Nurse Practitioner, Physician Assistant.

CPT 58100

Biopsy of lining of uterus

$94.81Medicare-allowed amount per service, averaged across 4,714 services

Providers submitted

$357.17

Asking price, not received

Medicare allowed

$94.81

The fee schedule figure

Medicare paid

$70.98

Balance is patient coinsurance

Providers submitted an average of $357.17 for this code and Medicare allowed $94.81 — 3.8× 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 $70.98 (75%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $97.03
Hospital / facility: $60.05

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. 4,431 services were billed in an office setting and 283 in a facility.

Services: 4,714
Beneficiaries: 4,568
Providers billing it: 318
Total allowed: $446,934

What Medicare pays for CPT 58100

Across 4,714 services billed by 318 providers to 4,568 beneficiaries, Medicare allowed an average of $94.81 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 58100

Specialty	Services	Beneficiaries	Avg allowed	Providers
Obstetrics & Gynecology	4,045	3,923	$96.13	271
Gynecological Oncology	376	359	$94.60	26
Nurse Practitioner	216	211	$75.99	15
Physician Assistant	50	48	$67.46	4
Urology	15	15	$93.21	1
Pediatric Medicine	12	12	$113.11	1

58100 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	775	$105.64	$72.17	51
Florida	603	$99.11	$73.87	39
New York	566	$95.88	$64.14	39
Massachusetts	343	$92.07	$67.41	22
Pennsylvania	324	$95.04	$69.40	21
New Jersey	253	$104.76	$71.70	18
Illinois	180	$90.15	$62.39	12
Arizona	156	$96.26	$76.43	8
Texas	133	$91.09	$71.76	9
Virginia	132	$80.23	$62.59	9
Maryland	114	$98.61	$71.48	8
Ohio	108	$83.84	$65.03	8
Iowa	105	$79.43	$64.95	7
Georgia	86	$83.43	$65.47	7
Tennessee	79	$82.59	$66.29	6
Wisconsin	69	$66.48	$52.72	5
South Carolina	66	$93.88	$77.06	5
North Carolina	60	$92.29	$70.07	4
Indiana	55	$88.68	$75.87	4
Nebraska	55	$77.84	$66.89	3
Oklahoma	46	$90.91	$75.42	3
Oregon	39	$86.52	$69.47	3
Kansas	37	$75.19	$63.90	3
Washington	37	$89.60	$67.71	3
Delaware	35	$90.70	$78.63	2
Missouri	34	$95.10	$75.45	2
Michigan	31	$95.71	$76.34	2
Colorado	29	$78.62	$61.77	2
Arkansas	26	$88.44	$69.40	2
Louisiana	25	$91.42	$79.76	2
New Hampshire	25	$79.68	$51.92	2
South Dakota	22	$77.12	$62.53	2
Montana	18	$84.91	$63.99	1
Alaska	12	$121.31	$79.74	1
Alabama	12	$111.63	$75.46	1
Utah	12	$96.02	$79.75	1
District of Columbia	12	$113.11	$79.42	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.