How much does Medicare pay for CPT 72128?

Medicare allowed an average of $46.63 per service and paid $35.76 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $301.84, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 72128?

Ct scan of middle spine without contrast. It was billed 176,933 times to 175,361 Medicare beneficiaries by 6,615 providers in 2024.

Does 72128 pay differently in an office than a hospital?

Yes. The allowed amount averaged $95.46 in an office setting and $44.62 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 72128 most?

Diagnostic Radiology, with 170,762 services from 6,351 clinicians. Next are Interventional Radiology, Independent Diagnostic Testing Facility (IDTF), Neurosurgery.

CPT 72128

Ct scan of middle spine without contrast

$46.63Medicare-allowed amount per service, averaged across 176,933 services

Providers submitted

$301.84

Asking price, not received

Medicare allowed

$46.63

The fee schedule figure

Medicare paid

$35.76

Balance is patient coinsurance

Providers submitted an average of $301.84 for this code and Medicare allowed $46.63 — 6.5× 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 $35.76 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $95.46
Hospital / facility: $44.62

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. 6,989 services were billed in an office setting and 169,944 in a facility.

Services: 176,933
Beneficiaries: 175,361
Providers billing it: 6,615
Total allowed: $8,250,386

What Medicare pays for CPT 72128

Across 176,933 services billed by 6,615 providers to 175,361 beneficiaries, Medicare allowed an average of $46.63 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 72128

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	170,762	169,336	$46.21	6,351
Interventional Radiology	3,856	3,821	$46.63	154
Independent Diagnostic Testing Facility (IDTF)	1,168	1,088	$102.02	64
Neurosurgery	195	175	$64.83	8
Neurology	164	162	$43.61	4
Undefined Physician type	162	159	$42.96	4
Nuclear Medicine	108	106	$44.36	8
Orthopedic Surgery	98	95	$92.67	5
Vascular Surgery	95	95	$43.82	1
Internal Medicine	87	87	$44.33	3
Radiation Oncology	83	82	$45.10	4
Nurse Practitioner	37	37	$53.27	2
Pain Management	34	34	$45.86	2
General Surgery	24	24	$46.06	1
Emergency Medicine	20	20	$43.15	1

72128 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
Texas	17,743	$46.13	$34.78	603
California	15,615	$50.97	$35.56	581
Florida	14,367	$48.23	$35.42	539
New York	10,347	$52.48	$35.52	299
Ohio	9,804	$44.20	$32.96	342
Minnesota	8,565	$45.85	$33.75	327
Pennsylvania	7,345	$44.53	$33.27	224
Illinois	6,667	$45.08	$32.95	254
Missouri	6,653	$44.24	$33.56	210
Michigan	6,066	$45.04	$33.24	229
North Carolina	4,879	$45.36	$34.63	205
Arizona	4,719	$47.61	$35.78	154
Virginia	4,297	$45.08	$33.24	170
Massachusetts	4,056	$46.91	$33.52	140
Georgia	3,633	$46.53	$34.71	131
Washington	3,591	$47.49	$32.95	140
Colorado	3,202	$46.38	$33.01	131
Alabama	3,045	$43.14	$33.20	129
Tennessee	2,967	$44.51	$33.93	130
Maryland	2,819	$52.25	$37.42	126
Indiana	2,676	$43.40	$33.35	99
Kansas	2,617	$43.45	$33.94	94
Kentucky	2,486	$43.97	$33.57	96
Oklahoma	2,193	$44.59	$34.47	108
New Jersey	2,172	$52.68	$36.29	96
Wisconsin	2,013	$43.16	$31.76	88
Utah	2,007	$43.54	$33.34	90
Arkansas	1,808	$42.44	$33.06	81
Connecticut	1,671	$47.20	$33.82	78
Nebraska	1,510	$42.90	$33.03	58
Nevada	1,447	$47.16	$35.51	65
Mississippi	1,342	$42.95	$33.23	62
Rhode Island	1,318	$47.32	$33.93	42
Oregon	1,224	$44.93	$32.79	53
South Carolina	1,126	$42.91	$32.84	53
West Virginia	1,079	$44.50	$32.55	49
New Hampshire	1,061	$43.99	$32.41	30
Louisiana	1,036	$50.39	$38.69	54
Iowa	952	$42.67	$32.86	40
District of Columbia	731	$51.68	$36.45	30
New Mexico	597	$46.83	$35.02	24
North Dakota	532	$43.63	$32.77	25
Idaho	491	$43.09	$32.54	26
South Dakota	432	$43.83	$32.60	21
Hawaii	384	$45.02	$32.64	21
Vermont	362	$43.23	$31.26	11
Delaware	315	$47.86	$36.38	11
Wyoming	230	$43.87	$31.43	13
Alaska	197	$66.15	$38.90	7
Maine	194	$44.14	$32.93	9
Montana	124	$44.57	$31.93	9
Puerto Rico	113	$43.45	$32.81	4
AA	56	$43.88	$33.83	2
ZZ	40	$43.38	$33.84	1
AP	17	$45.11	$29.66	1

Related codes

72125Ct scan of upper spine without contrast$46.99
72100X-ray of lower and sacral spine$23.76
72148Mri scan of lower spinal canal without contrast$116.92
72110X-ray of lower and sacral spine$34.78
72170X-ray of pelvis$13.01
72141Mri scan of upper spinal canal without contrast$108.96
72131Ct scan of lower spine without contrast$53.06
72197Mri scan of pelvis before and after contrast$191.31
72146Mri scan of middle spinal canal without contrast$99.42
72158Mri scan of lower spinal canal before and after contrast$149.73
72192Ct scan of pelvis without contrast$53.35
72156Mri scan of upper spinal canal before and after contrast$142.72

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.