How much does Medicare pay for CPT 69420?

Medicare allowed an average of $196.12 per service and paid $149.12 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $522.80, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 69420?

Incision, aspiration, and/or inflation of eardrum. It was billed 3,407 times to 3,092 Medicare beneficiaries by 191 providers in 2024.

Does 69420 pay differently in an office than a hospital?

Yes. The allowed amount averaged $197.17 in an office setting and $110.12 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 69420 most?

Otolaryngology, with 3,131 services from 172 clinicians. Next are Physician Assistant, Nurse Practitioner.

CPT 69420

Incision, aspiration, and/or inflation of eardrum

$196.12Medicare-allowed amount per service, averaged across 3,407 services

Providers submitted

$522.80

Asking price, not received

Medicare allowed

$196.12

The fee schedule figure

Medicare paid

$149.12

Balance is patient coinsurance

Providers submitted an average of $522.80 for this code and Medicare allowed $196.12 — 2.7× 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 $149.12 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $197.17
Hospital / facility: $110.12

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. 3,366 services were billed in an office setting and 41 in a facility.

Services: 3,407
Beneficiaries: 3,092
Providers billing it: 191
Total allowed: $668,181

What Medicare pays for CPT 69420

Across 3,407 services billed by 191 providers to 3,092 beneficiaries, Medicare allowed an average of $196.12 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 69420

Specialty	Services	Beneficiaries	Avg allowed	Providers
Otolaryngology	3,131	2,827	$199.27	172
Physician Assistant	176	171	$164.71	12
Nurse Practitioner	100	94	$152.88	7

69420 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	400	$194.90	$149.04	17
Texas	348	$190.92	$154.51	21
Pennsylvania	273	$203.56	$153.09	15
South Carolina	200	$184.39	$154.18	10
Maryland	195	$214.45	$154.59	11
Virginia	193	$189.31	$145.16	12
California	190	$233.58	$151.48	12
Tennessee	190	$171.90	$146.38	11
New York	150	$235.14	$159.72	8
New Jersey	142	$232.49	$158.76	9
Arizona	107	$185.27	$149.30	5
Louisiana	105	$184.98	$153.02	6
Ohio	104	$174.14	$139.98	6
Illinois	94	$201.83	$156.59	6
Arkansas	80	$169.77	$143.21	4
Mississippi	63	$167.33	$145.00	3
North Carolina	61	$178.35	$143.08	3
Indiana	50	$184.05	$143.69	3
Kansas	47	$187.23	$156.72	3
Alabama	45	$181.35	$151.54	3
Massachusetts	39	$217.02	$161.31	3
Missouri	36	$184.59	$154.72	3
Connecticut	34	$242.27	$174.47	1
Georgia	32	$193.88	$149.42	2
Michigan	31	$162.91	$125.79	2
Kentucky	27	$172.09	$132.99	1
Colorado	26	$186.97	$144.34	2
District of Columbia	23	$215.74	$146.11	1
West Virginia	22	$194.36	$132.46	1
Washington	18	$248.20	$162.72	1
Wisconsin	16	$119.00	$82.53	1
Oregon	15	$190.90	$155.60	1
Rhode Island	14	$188.10	$150.29	1
Iowa	13	$93.83	$81.19	1
Idaho	12	$194.21	$151.70	1
New Hampshire	12	$115.93	$95.25	1

Related codes

69433Incision of eardrum$206.12
69436Incision of eardrum$352.33

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.