How much does Medicare pay for CPT 69801?

Medicare allowed an average of $202.66 per service and paid $157.25 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1591.89, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 69801?

Incision of fluid canal of inner ear with infusion of drugs. It was billed 6,979 times to 2,801 Medicare beneficiaries by 142 providers in 2024.

Does 69801 pay differently in an office than a hospital?

Yes. The allowed amount averaged $222.34 in an office setting and $113.33 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 69801 most?

Otolaryngology, with 6,082 services from 124 clinicians. Next are Ambulatory Surgical Center, Physician Assistant, Nurse Practitioner.

CPT 69801

Incision of fluid canal of inner ear with infusion of drugs

$202.66Medicare-allowed amount per service, averaged across 6,979 services

Providers submitted

$1591.89

Asking price, not received

Medicare allowed

$202.66

The fee schedule figure

Medicare paid

$157.25

Balance is patient coinsurance

Providers submitted an average of $1591.89 for this code and Medicare allowed $202.66 — 7.9× 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 $157.25 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $222.34
Hospital / facility: $113.33

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. 5,719 services were billed in an office setting and 1,260 in a facility.

Services: 6,979
Beneficiaries: 2,801
Providers billing it: 142
Total allowed: $1,414,364

What Medicare pays for CPT 69801

Across 6,979 services billed by 142 providers to 2,801 beneficiaries, Medicare allowed an average of $202.66 per service. That is 2.5 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 69801

Specialty	Services	Beneficiaries	Avg allowed	Providers
Otolaryngology	6,082	2,387	$209.88	124
Ambulatory Surgical Center	428	197	$121.75	3
Physician Assistant	308	133	$176.45	9
Nurse Practitioner	134	72	$182.89	5
Neurology	27	12	$254.26	1

69801 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
Tennessee	975	$146.55	$125.30	9
Alabama	909	$195.81	$166.11	6
Texas	798	$209.61	$175.15	19
Florida	751	$213.99	$161.22	15
Arizona	455	$213.34	$173.18	10
California	376	$220.87	$154.94	11
Indiana	292	$221.34	$192.25	4
New Jersey	261	$274.75	$182.06	4
New York	237	$260.33	$180.35	7
South Carolina	203	$200.72	$165.18	4
Maryland	154	$230.46	$164.66	5
Michigan	153	$219.10	$174.24	5
Pennsylvania	149	$214.91	$162.94	4
Massachusetts	144	$126.40	$93.34	5
Kansas	139	$206.71	$177.28	3
Virginia	131	$239.02	$174.89	3
Missouri	123	$196.72	$162.36	3
Ohio	112	$135.08	$106.09	5
Mississippi	95	$194.41	$174.39	2
Washington	82	$245.40	$172.93	3
Illinois	82	$202.57	$152.91	3
Colorado	81	$195.25	$153.32	3
Kentucky	77	$215.33	$188.67	2
North Carolina	66	$217.27	$171.88	2
Arkansas	63	$192.79	$171.56	2
Montana	27	$190.77	$142.26	1
Oregon	22	$221.50	$179.02	1
Iowa	22	$175.45	$150.72	1

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.