How much does Medicare pay for CPT 69433?

Medicare allowed an average of $206.12 per service and paid $155.43 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $643.83, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 69433?

Incision of eardrum with insertion of eardrum tube under local or topical anesthesia. It was billed 15,225 times to 13,549 Medicare beneficiaries by 805 providers in 2024.

Does 69433 pay differently in an office than a hospital?

Yes. The allowed amount averaged $209.87 in an office setting and $139.40 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 69433 most?

Otolaryngology, with 14,694 services from 778 clinicians. Next are Physician Assistant, Ambulatory Surgical Center, Nurse Practitioner.

CPT 69433

Incision of eardrum with insertion of eardrum tube under local or topical anesthesia

$206.12Medicare-allowed amount per service, averaged across 15,225 services

Providers submitted

$643.83

Asking price, not received

Medicare allowed

$206.12

The fee schedule figure

Medicare paid

$155.43

Balance is patient coinsurance

Providers submitted an average of $643.83 for this code and Medicare allowed $206.12 — 3.1× 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 $155.43 (75%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $209.87
Hospital / facility: $139.40

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. 14,414 services were billed in an office setting and 811 in a facility.

Services: 15,225
Beneficiaries: 13,549
Providers billing it: 805
Total allowed: $3,138,177

What Medicare pays for CPT 69433

Across 15,225 services billed by 805 providers to 13,549 beneficiaries, Medicare allowed an average of $206.12 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 69433

Specialty	Services	Beneficiaries	Avg allowed	Providers
Otolaryngology	14,694	13,087	$207.28	778
Physician Assistant	341	294	$171.58	16
Ambulatory Surgical Center	68	61	$145.39	4
Nurse Practitioner	52	42	$155.27	3
Neurology	44	41	$230.43	2
Pain Management	13	11	$267.95	1
General Surgery	13	13	$180.04	1

69433 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	1,301	$209.60	$160.66	63
Texas	1,120	$206.01	$165.31	56
Pennsylvania	878	$209.54	$157.17	48
South Carolina	797	$193.42	$158.43	42
California	765	$234.00	$156.36	47
New York	684	$239.22	$159.44	35
Illinois	662	$196.64	$141.35	31
Maryland	648	$223.74	$164.23	29
Virginia	598	$213.59	$163.87	29
Kansas	545	$196.96	$164.88	22
Michigan	494	$205.97	$159.62	26
Ohio	490	$189.05	$150.53	32
Tennessee	435	$187.67	$155.74	26
Missouri	431	$185.23	$148.16	23
New Jersey	393	$229.72	$155.28	20
Washington	389	$225.82	$164.33	20
Mississippi	372	$185.60	$164.21	17
North Carolina	355	$204.98	$160.39	23
Kentucky	325	$195.64	$164.58	21
Indiana	315	$194.83	$154.84	16
Iowa	298	$184.87	$151.16	17
Massachusetts	270	$212.19	$145.27	15
Arizona	245	$208.25	$164.63	13
Arkansas	244	$177.10	$147.58	11
Alabama	241	$189.38	$160.59	12
Georgia	234	$201.04	$161.84	15
Oklahoma	215	$204.78	$169.80	11
Wisconsin	190	$194.49	$147.11	13
Delaware	164	$210.54	$162.73	6
Oregon	120	$205.09	$150.79	7
Louisiana	119	$200.32	$167.19	6
Connecticut	112	$227.89	$159.95	7
Minnesota	94	$210.99	$161.68	6
Nebraska	89	$181.86	$150.99	5
Montana	69	$184.80	$127.99	3
West Virginia	64	$201.45	$152.82	4
District of Columbia	63	$227.33	$147.04	3
Utah	55	$213.39	$177.35	3
Colorado	51	$203.46	$163.16	3
North Dakota	50	$185.51	$144.21	3
South Dakota	48	$175.27	$124.67	3
Nevada	41	$213.06	$164.85	3
New Hampshire	36	$171.87	$130.27	3
Hawaii	34	$213.25	$175.28	2
Idaho	27	$182.51	$149.48	2
Rhode Island	27	$220.30	$157.97	1
Guam	14	$178.80	$162.09	1
Wyoming	14	$206.17	$145.20	1

Related codes

69420Incision, aspiration, and/or inflation of eardrum$196.12
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.