How much does Medicare pay for CPT 74221?

Medicare allowed an average of $49.22 per service and paid $36.63 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $205.68, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 74221?

Double contrast x-ray of esophagus. It was billed 43,862 times to 43,689 Medicare beneficiaries by 2,002 providers in 2024.

Does 74221 pay differently in an office than a hospital?

Yes. The allowed amount averaged $92.80 in an office setting and $31.84 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 74221 most?

Diagnostic Radiology, with 39,124 services from 1,806 clinicians. Next are Physician Assistant, Independent Diagnostic Testing Facility (IDTF), Interventional Radiology.

CPT 74221

Double contrast x-ray of esophagus

$49.22Medicare-allowed amount per service, averaged across 43,862 services

Providers submitted

$205.68

Asking price, not received

Medicare allowed

$49.22

The fee schedule figure

Medicare paid

$36.63

Balance is patient coinsurance

Providers submitted an average of $205.68 for this code and Medicare allowed $49.22 — 4.2× 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 $36.63 (74%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $92.80
Hospital / facility: $31.84

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. 12,506 services were billed in an office setting and 31,356 in a facility.

Services: 43,862
Beneficiaries: 43,689
Providers billing it: 2,002
Total allowed: $2,158,888

What Medicare pays for CPT 74221

Across 43,862 services billed by 2,002 providers to 43,689 beneficiaries, Medicare allowed an average of $49.22 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 74221

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	39,124	38,966	$49.18	1,806
Physician Assistant	1,725	1,725	$30.41	80
Independent Diagnostic Testing Facility (IDTF)	1,099	1,089	$100.70	24
Interventional Radiology	993	990	$39.69	56
Nurse Practitioner	587	585	$26.81	22
Radiation Oncology	181	181	$51.54	3
Nuclear Medicine	64	64	$50.14	4
Family Practice	15	15	$67.81	1
Neurology	13	13	$31.65	1
Pediatric Medicine	13	13	$31.03	1
Preventive Medicine	13	13	$37.00	1
Internal Medicine	12	12	$30.87	1
Emergency Medicine	12	12	$31.44	1
Otolaryngology	11	11	$99.34	1

74221 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	3,619	$56.94	$37.63	148
Virginia	3,203	$44.78	$33.04	120
Texas	2,917	$58.97	$44.43	126
Florida	2,771	$62.56	$46.70	107
Massachusetts	2,427	$36.38	$24.58	94
Pennsylvania	2,091	$34.37	$23.88	96
North Carolina	1,794	$38.82	$28.86	84
Arizona	1,645	$89.50	$65.95	38
New York	1,451	$67.36	$44.10	79
South Carolina	1,420	$30.84	$23.61	61
Illinois	1,408	$45.74	$33.09	73
Georgia	1,278	$34.40	$25.01	72
Ohio	1,276	$35.02	$25.50	67
Tennessee	1,170	$47.84	$37.84	65
Colorado	1,157	$38.51	$26.73	35
Washington	1,091	$49.76	$35.59	56
Indiana	994	$30.97	$23.66	46
Maryland	992	$89.86	$62.29	41
Michigan	868	$35.13	$26.04	45
Missouri	793	$47.05	$36.30	45
New Jersey	724	$86.12	$59.71	44
Minnesota	636	$74.46	$52.56	34
Kentucky	589	$31.24	$23.41	31
Alabama	584	$32.75	$25.14	32
Arkansas	562	$39.83	$32.73	27
Nevada	542	$85.63	$63.12	31
Oregon	522	$47.29	$33.44	30
Utah	433	$26.69	$20.08	19
Iowa	429	$35.76	$27.81	25
Connecticut	406	$63.56	$45.99	18
Idaho	374	$33.83	$24.83	19
Rhode Island	307	$30.47	$21.74	12
New Hampshire	298	$31.87	$22.93	15
Montana	290	$32.04	$22.21	16
Mississippi	254	$30.39	$23.27	16
New Mexico	247	$54.03	$41.31	12
Maine	239	$32.41	$21.24	14
Delaware	236	$48.86	$35.57	11
Louisiana	236	$30.75	$23.31	12
Kansas	234	$53.07	$43.25	14
Nebraska	221	$45.27	$35.98	13
West Virginia	198	$37.63	$28.52	10
Wisconsin	179	$31.23	$23.73	11
District of Columbia	153	$53.97	$40.41	7
Vermont	149	$31.37	$22.77	4
Wyoming	129	$45.03	$36.28	7
Oklahoma	98	$30.67	$22.54	7
North Dakota	84	$31.17	$22.74	5
Alaska	83	$53.91	$33.46	4
South Dakota	26	$63.06	$43.42	2
XX	20	$33.29	$23.50	1
Hawaii	15	$105.21	$73.73	1

Related codes

74230Imaging for evaluation of swallowing function$30.38
74220Single contrast x-ray of esophagus$35.23
74240Single contrast x-ray of upper digestive tract$66.13
74246Double contrast x-ray of upper digestive tract$63.10
74250Single contrast x-ray of small intestine$38.13
74261Diagnostic ct scan of large intestine without contrast$161.07
74270Single contrast x-ray of large intestine$64.16

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.