How much does Medicare pay for CPT 62264?

Medicare allowed an average of $360.21 per service and paid $280.37 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $2097.78, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 62264?

Removal of spinal canal scar tissue, multiple sessions in 1 day. It was billed 4,020 times to 3,084 Medicare beneficiaries by 81 providers in 2024.

Does 62264 pay differently in an office than a hospital?

Yes. The allowed amount averaged $417.65 in an office setting and $321.56 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 62264 most?

Interventional Pain Management, with 1,331 services from 26 clinicians. Next are Ambulatory Surgical Center, Pain Management, Anesthesiology.

CPT 62264

Removal of spinal canal scar tissue, multiple sessions in 1 day

$360.21Medicare-allowed amount per service, averaged across 4,020 services

Providers submitted

$2097.78

Asking price, not received

Medicare allowed

$360.21

The fee schedule figure

Medicare paid

$280.37

Balance is patient coinsurance

Providers submitted an average of $2097.78 for this code and Medicare allowed $360.21 — 5.8× 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 $280.37 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $417.65
Hospital / facility: $321.56

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. 1,617 services were billed in an office setting and 2,403 in a facility.

Services: 4,020
Beneficiaries: 3,084
Providers billing it: 81
Total allowed: $1,448,044

What Medicare pays for CPT 62264

Across 4,020 services billed by 81 providers to 3,084 beneficiaries, Medicare allowed an average of $360.21 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 62264

Specialty	Services	Beneficiaries	Avg allowed	Providers
Interventional Pain Management	1,331	982	$350.45	26
Ambulatory Surgical Center	1,093	876	$419.89	19
Pain Management	880	717	$326.93	20
Anesthesiology	659	459	$330.59	13
Orthopedic Surgery	26	26	$257.20	1
Addiction Medicine	16	13	$440.82	1
Physical Medicine and Rehabilitation	15	11	$224.20	1

62264 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
Florida	927	$381.71	$297.22	19
Texas	682	$368.18	$295.22	18
California	504	$328.85	$235.02	4
Illinois	361	$366.60	$286.53	5
Michigan	290	$351.32	$266.94	7
Louisiana	289	$316.04	$275.43	5
New York	239	$472.62	$334.50	5
Massachusetts	221	$339.20	$258.17	4
Missouri	159	$294.41	$236.33	4
Indiana	126	$321.24	$261.05	2
Wisconsin	81	$409.35	$331.65	1
Ohio	38	$347.28	$292.83	3
Arkansas	38	$385.17	$339.97	1
Maryland	31	$251.64	$179.37	1
Connecticut	19	$233.52	$189.76	1
Kansas	15	$224.20	$188.80	1

Related codes

62270Removal of cerebrospinal fluid$92.02
62252Reprogramming of cerebrospinal fluid shunt$67.99
62284Injection of contrast for imaging of lower spinal canal$81.56
62290Injection of contrast for imaging of each level of lower spine$192.84
62223Creation of brain fluid drainage shunt$693.11

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.