How much does Medicare pay for CPT 76080?

Medicare allowed an average of $24.07 per service and paid $18.89 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $134.15, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 76080?

Review by radiologist of abscess or sinus cavity study. It was billed 5,504 times to 3,917 Medicare beneficiaries by 235 providers in 2024.

Does 76080 pay differently in an office than a hospital?

Yes. The allowed amount averaged $31.34 in an office setting and $23.98 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 76080 most?

Interventional Radiology, with 2,591 services from 115 clinicians. Next are Diagnostic Radiology, Physician Assistant, Nurse Practitioner.

CPT 76080

Review by radiologist of abscess or sinus cavity study

$24.07Medicare-allowed amount per service, averaged across 5,504 services

Providers submitted

$134.15

Asking price, not received

Medicare allowed

$24.07

The fee schedule figure

Medicare paid

$18.89

Balance is patient coinsurance

Providers submitted an average of $134.15 for this code and Medicare allowed $24.07 — 5.6× 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 $18.89 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $31.34
Hospital / facility: $23.98

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. 66 services were billed in an office setting and 5,438 in a facility.

Services: 5,504
Beneficiaries: 3,917
Providers billing it: 235
Total allowed: $132,481

What Medicare pays for CPT 76080

Across 5,504 services billed by 235 providers to 3,917 beneficiaries, Medicare allowed an average of $24.07 per service. That is 1.4 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 76080

Specialty	Services	Beneficiaries	Avg allowed	Providers
Interventional Radiology	2,591	1,899	$24.15	115
Diagnostic Radiology	2,497	1,726	$24.19	103
Physician Assistant	263	191	$20.30	11
Nurse Practitioner	66	31	$31.34	2
Cardiology	28	22	$24.18	1
Interventional Cardiology	26	20	$24.74	1
Vascular Surgery	19	16	$23.33	1
Undefined Physician type	14	12	$23.46	1

76080 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
Pennsylvania	766	$24.58	$17.80	35
Minnesota	649	$23.76	$17.85	19
California	466	$25.48	$18.07	20
Illinois	398	$25.33	$17.62	15
New Jersey	326	$25.37	$17.94	15
Iowa	261	$22.85	$17.86	7
Missouri	246	$21.85	$16.72	11
South Dakota	230	$23.22	$17.81	9
New York	217	$28.20	$18.28	10
Nebraska	211	$22.34	$18.19	10
Michigan	173	$23.51	$18.09	11
New Hampshire	145	$23.34	$17.68	7
Florida	135	$24.55	$17.92	7
Texas	124	$23.18	$18.27	5
North Dakota	124	$23.30	$17.93	6
Arizona	110	$22.85	$18.11	4
Wisconsin	105	$23.15	$17.86	5
Oklahoma	95	$23.11	$18.25	4
Washington	93	$25.11	$17.26	4
Idaho	89	$22.84	$18.00	5
Rhode Island	87	$23.85	$18.04	2
Louisiana	70	$23.16	$18.24	2
Vermont	58	$20.49	$15.55	2
Ohio	56	$24.62	$18.20	3
Arkansas	53	$22.37	$17.52	4
New Mexico	51	$21.78	$16.56	3
Maryland	48	$24.83	$18.21	3
Connecticut	34	$22.54	$16.44	2
Virginia	20	$26.68	$18.19	1
South Carolina	17	$23.07	$18.12	1
North Carolina	16	$23.05	$18.23	1
Massachusetts	16	$21.65	$15.51	1
Utah	15	$19.92	$14.46	1

Related codes

76000Imaging guidance for procedure$27.31
76098X-ray of surgical specimen$15.67

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.