How much does Medicare pay for CPT 69220?

Medicare allowed an average of $77.51 per service and paid $55.15 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $309.31, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 69220?

Simple removal of skin debris and drainage of mastoid cavity. It was billed 12,978 times to 7,772 Medicare beneficiaries by 360 providers in 2024.

Does 69220 pay differently in an office than a hospital?

Yes. The allowed amount averaged $79.46 in an office setting and $54.92 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 69220 most?

Otolaryngology, with 11,909 services from 322 clinicians. Next are Physician Assistant, Nurse Practitioner, Family Practice.

CPT 69220

Simple removal of skin debris and drainage of mastoid cavity

$77.51Medicare-allowed amount per service, averaged across 12,978 services

Providers submitted

$309.31

Asking price, not received

Medicare allowed

$77.51

The fee schedule figure

Medicare paid

$55.15

Balance is patient coinsurance

Providers submitted an average of $309.31 for this code and Medicare allowed $77.51 — 4.0× 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 $55.15 (71%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $79.46
Hospital / facility: $54.92

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. 11,946 services were billed in an office setting and 1,032 in a facility.

Services: 12,978
Beneficiaries: 7,772
Providers billing it: 360
Total allowed: $1,005,925

What Medicare pays for CPT 69220

Across 12,978 services billed by 360 providers to 7,772 beneficiaries, Medicare allowed an average of $77.51 per service. That is 1.7 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 69220

Specialty	Services	Beneficiaries	Avg allowed	Providers
Otolaryngology	11,909	7,075	$78.40	322
Physician Assistant	609	380	$63.99	24
Nurse Practitioner	261	161	$64.99	12
Family Practice	141	117	$84.39	1
Neurology	58	39	$76.44	1

69220 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	1,517	$78.32	$55.15	44
California	1,304	$85.33	$57.17	29
New York	1,248	$82.88	$52.62	29
Arizona	729	$71.04	$50.89	11
Pennsylvania	629	$71.78	$49.15	21
Texas	613	$78.30	$57.95	17
Illinois	499	$72.29	$49.38	20
Massachusetts	495	$74.00	$48.17	14
Delaware	475	$86.05	$61.98	10
Maryland	398	$81.04	$55.37	12
Michigan	390	$80.76	$56.33	12
Oklahoma	382	$75.20	$57.82	5
Indiana	306	$71.19	$57.44	7
Missouri	285	$73.35	$56.07	7
Virginia	265	$77.58	$54.66	10
Washington	256	$79.22	$52.39	7
New Jersey	255	$87.70	$58.68	6
Rhode Island	220	$93.33	$68.96	3
Ohio	217	$69.74	$49.65	9
Oregon	188	$74.52	$51.98	7
Iowa	179	$64.41	$50.27	7
Georgia	175	$77.48	$56.56	6
Tennessee	174	$77.34	$59.18	6
North Carolina	173	$70.53	$50.80	7
Wisconsin	161	$79.89	$62.25	4
South Carolina	134	$74.27	$53.43	4
Colorado	120	$72.53	$52.81	3
Mississippi	107	$68.16	$55.60	3
Kansas	106	$73.18	$58.47	3
Nevada	105	$81.84	$60.36	3
Louisiana	95	$70.49	$47.94	3
West Virginia	94	$64.19	$42.14	3
Montana	78	$78.58	$49.99	3
Vermont	64	$50.21	$35.39	2
New Mexico	62	$71.93	$45.93	2
South Dakota	47	$70.95	$44.52	2
Alabama	45	$66.39	$51.78	2
Kentucky	44	$75.04	$51.13	2
District of Columbia	39	$94.18	$52.11	2
North Dakota	36	$48.62	$40.07	1
Utah	34	$74.11	$58.81	2
Arkansas	34	$67.02	$51.24	1
Maine	33	$49.29	$33.04	1
Nebraska	31	$69.50	$55.69	1
Minnesota	31	$75.59	$52.81	2
New Hampshire	29	$53.66	$39.85	2
Idaho	28	$71.14	$48.08	1
Wyoming	26	$75.11	$47.21	1
Connecticut	23	$84.63	$60.12	1

Related codes

69210Removal of impacted ear wax$41.92
69209Removal of impacted ear wax by washing$17.47
69200Removal of foreign body in ear canal$79.09
69222Complex removal of skin debris and drainage of mastoid cavity$224.70

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.