How much does Medicare pay for CPT 69100?

Medicare allowed an average of $64.23 per service and paid $47.26 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $220.40, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 69100?

Biopsy of ear. It was billed 121,645 times to 110,539 Medicare beneficiaries by 4,777 providers in 2024.

Does 69100 pay differently in an office than a hospital?

Yes. The allowed amount averaged $64.48 in an office setting and $29.85 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 69100 most?

Dermatology, with 80,735 services from 2,964 clinicians. Next are Physician Assistant, Nurse Practitioner, Micrographic Dermatologic Surgery.

CPT 69100

Biopsy of ear

$64.23Medicare-allowed amount per service, averaged across 121,645 services

Providers submitted

$220.40

Asking price, not received

Medicare allowed

$64.23

The fee schedule figure

Medicare paid

$47.26

Balance is patient coinsurance

Providers submitted an average of $220.40 for this code and Medicare allowed $64.23 — 3.4× 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 $47.26 (74%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $64.48
Hospital / facility: $29.85

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. 120,773 services were billed in an office setting and 872 in a facility.

Services: 121,645
Beneficiaries: 110,539
Providers billing it: 4,777
Total allowed: $7,813,258

What Medicare pays for CPT 69100

Across 121,645 services billed by 4,777 providers to 110,539 beneficiaries, Medicare allowed an average of $64.23 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 69100

Specialty	Services	Beneficiaries	Avg allowed	Providers
Dermatology	80,735	72,934	$67.67	2,964
Physician Assistant	27,250	25,082	$57.21	1,221
Nurse Practitioner	10,464	9,637	$56.30	471
Micrographic Dermatologic Surgery	2,029	1,834	$62.47	80
Family Practice	286	254	$65.36	8
Internal Medicine	243	223	$70.00	8
Undefined Physician type	165	141	$58.94	4
Plastic and Reconstructive Surgery	132	118	$62.89	7
Pathology	77	69	$66.43	3
Pediatric Medicine	73	63	$58.82	2
Emergency Medicine	49	49	$79.02	2
General Surgery	40	38	$66.29	1
Ambulatory Surgical Center	25	22	$25.76	1
Osteopathic Manipulative Medicine	25	23	$66.55	2
Interventional Pain Management	22	22	$69.23	1

69100 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	24,082	$60.56	$44.62	746
California	10,288	$72.89	$47.92	382
Texas	8,948	$64.55	$48.08	345
Arizona	6,171	$64.72	$46.48	230
North Carolina	4,377	$62.29	$47.54	185
Georgia	4,255	$62.09	$46.99	173
New York	4,220	$72.50	$47.71	150
Pennsylvania	3,620	$65.17	$47.35	147
South Carolina	3,599	$60.83	$46.86	119
Virginia	3,411	$67.47	$48.21	147
Tennessee	3,163	$58.65	$45.49	137
Illinois	2,757	$65.76	$47.15	123
New Jersey	2,627	$73.01	$48.15	110
Massachusetts	2,136	$72.43	$49.19	99
Maryland	2,125	$73.24	$49.25	91
Alabama	2,070	$56.94	$46.44	91
Colorado	2,004	$69.14	$48.64	98
Ohio	2,000	$61.23	$47.32	92
Missouri	1,955	$64.61	$49.82	86
Indiana	1,942	$62.90	$47.91	91
Arkansas	1,915	$57.50	$47.04	69
Kansas	1,913	$59.63	$45.61	68
Washington	1,846	$63.82	$44.29	94
Kentucky	1,756	$60.58	$48.40	70
Michigan	1,573	$68.05	$49.92	81
Mississippi	1,494	$55.76	$45.48	50
Oklahoma	1,451	$61.78	$48.06	61
Oregon	1,335	$66.15	$47.22	63
Iowa	1,207	$61.89	$47.26	53
Wisconsin	963	$58.98	$43.98	50
Utah	870	$62.98	$48.66	38
Nevada	818	$63.36	$46.42	42
Idaho	818	$60.29	$45.20	44
Louisiana	776	$62.01	$49.07	32
New Mexico	762	$60.92	$44.88	30
Minnesota	708	$59.79	$42.81	40
Nebraska	707	$63.12	$48.22	31
New Hampshire	693	$65.95	$46.48	34
Wyoming	569	$62.17	$44.52	19
South Dakota	555	$49.27	$37.78	20
West Virginia	520	$57.42	$45.26	25
Connecticut	520	$73.63	$49.29	29
Montana	472	$58.53	$41.24	16
Maine	459	$66.44	$48.04	18
Delaware	458	$69.59	$51.52	15
Rhode Island	236	$70.14	$48.74	15
Alaska	124	$73.53	$47.08	6
District of Columbia	109	$75.11	$51.77	6
Hawaii	94	$66.05	$46.54	5
North Dakota	88	$68.55	$49.16	5
Vermont	86	$69.27	$51.60	6

Related codes

69145Removal of growth in soft tissue of ear canal$529.88

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.