How much does Medicare pay for CPT 72040?

Medicare allowed an average of $23.72 per service and paid $17.33 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $97.45, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 72040?

X-ray of upper spine, 2-3 views. It was billed 454,448 times to 409,398 Medicare beneficiaries by 12,440 providers in 2024.

Does 72040 pay differently in an office than a hospital?

Yes. The allowed amount averaged $30.57 in an office setting and $10.53 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 72040 most?

Diagnostic Radiology, with 250,703 services from 7,143 clinicians. Next are Orthopedic Surgery, Portable X-Ray Supplier, Physician Assistant.

CPT 72040

X-ray of upper spine, 2-3 views

$23.72Medicare-allowed amount per service, averaged across 454,448 services

Providers submitted

$97.45

Asking price, not received

Medicare allowed

$23.72

The fee schedule figure

Medicare paid

$17.33

Balance is patient coinsurance

Providers submitted an average of $97.45 for this code and Medicare allowed $23.72 — 4.1× 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 $17.33 (73%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $30.57
Hospital / facility: $10.53

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. 299,035 services were billed in an office setting and 155,413 in a facility.

Services: 454,448
Beneficiaries: 409,398
Providers billing it: 12,440
Total allowed: $10,779,507

What Medicare pays for CPT 72040

Across 454,448 services billed by 12,440 providers to 409,398 beneficiaries, Medicare allowed an average of $23.72 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 72040

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	250,703	237,832	$17.47	7,143
Orthopedic Surgery	71,766	57,238	$36.94	1,924
Portable X-Ray Supplier	23,375	16,039	$21.67	157
Physician Assistant	20,965	18,176	$28.78	793
Independent Diagnostic Testing Facility (IDTF)	13,048	11,339	$35.79	295
Family Practice	10,583	10,164	$27.95	306
Nurse Practitioner	9,559	8,778	$29.06	364
Physical Medicine and Rehabilitation	9,310	8,881	$35.47	298
Neurosurgery	8,718	6,493	$33.18	262
Interventional Radiology	7,652	7,269	$16.33	230
Internal Medicine	5,644	5,373	$28.02	135
Sports Medicine	3,229	3,181	$37.72	140
Rheumatology	2,756	2,638	$36.53	83
Obstetrics & Gynecology	2,345	2,249	$21.19	8
Emergency Medicine	1,761	1,660	$27.16	28

72040 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
California	42,267	$29.27	$18.62	1,087
Texas	41,736	$24.78	$18.78	904
Florida	29,154	$28.97	$21.72	809
New York	25,118	$28.55	$18.73	586
Illinois	17,499	$21.36	$15.38	482
Ohio	17,403	$17.68	$13.64	386
Maryland	16,775	$27.43	$19.02	317
North Carolina	15,378	$24.65	$18.98	507
Tennessee	14,403	$23.85	$19.36	432
Pennsylvania	14,397	$19.29	$14.16	417
Georgia	13,275	$26.71	$20.62	447
Virginia	12,925	$24.06	$17.41	375
Missouri	11,748	$15.47	$11.93	318
Massachusetts	11,710	$18.04	$12.27	262
Indiana	10,863	$20.39	$16.26	267
South Carolina	10,481	$25.46	$20.14	315
Arizona	9,848	$28.22	$20.77	258
Louisiana	9,542	$21.79	$17.90	254
Minnesota	9,460	$19.64	$14.10	287
New Jersey	9,199	$33.87	$22.98	321
Michigan	8,421	$20.27	$15.09	284
Washington	8,402	$20.87	$14.22	230
Arkansas	7,846	$18.82	$15.46	195
Alabama	7,257	$25.27	$21.39	256
Oklahoma	7,075	$19.18	$15.40	201
Mississippi	6,959	$20.55	$16.77	189
Colorado	6,819	$22.25	$15.54	221
Wisconsin	5,882	$18.06	$13.30	186
Iowa	5,147	$16.77	$13.00	135
Kentucky	5,053	$21.42	$17.02	163
Oregon	4,654	$17.60	$12.61	139
Connecticut	4,183	$27.98	$19.33	153
Kansas	3,781	$15.41	$12.06	112
Nebraska	3,548	$15.21	$12.01	102
Nevada	3,073	$28.00	$20.31	112
New Hampshire	3,022	$20.98	$14.98	86
Utah	2,135	$19.44	$14.90	72
Delaware	1,993	$27.28	$19.91	52
Idaho	1,765	$14.01	$10.61	52
South Dakota	1,654	$17.43	$12.75	54
Montana	1,517	$15.03	$10.73	53
West Virginia	1,438	$12.84	$9.46	55
Alaska	1,355	$28.34	$17.73	38
Rhode Island	1,275	$25.52	$18.00	43
Hawaii	1,253	$20.57	$13.82	22
New Mexico	1,206	$24.97	$19.20	48
District of Columbia	1,085	$23.63	$16.10	29
North Dakota	992	$15.31	$10.82	28
Wyoming	814	$25.47	$18.99	27
Maine	668	$11.00	$7.68	30
Vermont	602	$11.98	$8.36	21
Puerto Rico	277	$29.66	$19.56	17
AA	61	$19.97	$15.67	1
ZZ	25	$10.37	$7.76	1
AP	16	$10.55	$6.78	1
U.S. Virgin Islands	14	$39.13	$24.37	1

Related codes

72050X-ray of upper spine$35.18
72070X-ray of middle spine$20.40
72082X-ray of entire middle and lower spine$39.67
72072X-ray of middle spine$19.03
72020X-ray of spine$14.55
72052X-ray of upper spine$42.79
72080X-ray of middle and lower spine$22.02
72083X-ray of entire middle and lower spine$38.30
72084X-ray of entire middle and lower spine$47.06
72081X-ray of entire middle and lower spine$28.90
72074X-ray of middle spine$26.65

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.