How much does Medicare pay for CPT 76098?

Medicare allowed an average of $15.67 per service and paid $12.34 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $63.03, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 76098?

X-ray of surgical specimen. It was billed 46,740 times to 42,859 Medicare beneficiaries by 1,910 providers in 2024.

Does 76098 pay differently in an office than a hospital?

Yes. The allowed amount averaged $21.05 in an office setting and $15.04 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 76098 most?

Diagnostic Radiology, with 27,670 services from 1,283 clinicians. Next are General Surgery, Pathology, Surgical Oncology.

CPT 76098

X-ray of surgical specimen

$15.67Medicare-allowed amount per service, averaged across 46,740 services

Providers submitted

$63.03

Asking price, not received

Medicare allowed

$15.67

The fee schedule figure

Medicare paid

$12.34

Balance is patient coinsurance

Providers submitted an average of $63.03 for this code and Medicare allowed $15.67 — 4.0× 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 $12.34 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $21.05
Hospital / facility: $15.04

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. 4,924 services were billed in an office setting and 41,816 in a facility.

Services: 46,740
Beneficiaries: 42,859
Providers billing it: 1,910
Total allowed: $732,416

What Medicare pays for CPT 76098

Across 46,740 services billed by 1,910 providers to 42,859 beneficiaries, Medicare allowed an average of $15.67 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 76098

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	27,670	25,546	$15.95	1,283
General Surgery	7,913	7,580	$14.98	259
Pathology	7,247	6,061	$15.50	255
Surgical Oncology	3,191	3,004	$14.77	87
Interventional Radiology	272	250	$16.51	12
Independent Diagnostic Testing Facility (IDTF)	173	172	$25.00	5
Clinical Laboratory	145	122	$15.33	2
Dermatology	38	36	$17.06	1
Emergency Medicine	34	34	$21.93	2
Obstetrics & Gynecology	25	23	$14.20	2
Physician Assistant	19	19	$14.38	1
Anesthesiology	13	12	$15.87	1

76098 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	5,586	$16.46	$11.73	200
Florida	3,982	$15.35	$11.57	135
New York	3,880	$16.88	$11.63	151
Texas	2,745	$14.60	$11.32	115
Massachusetts	2,545	$16.06	$11.62	84
Illinois	1,979	$15.27	$11.35	85
Pennsylvania	1,939	$15.19	$11.39	91
Ohio	1,871	$14.79	$11.44	81
Virginia	1,734	$15.38	$11.77	60
North Carolina	1,457	$18.51	$15.08	72
New Jersey	1,335	$17.50	$12.31	59
Arizona	1,324	$14.43	$11.45	42
South Carolina	1,002	$14.58	$11.59	33
Indiana	998	$14.18	$11.43	42
Washington	987	$19.45	$14.47	51
Missouri	954	$14.89	$11.71	44
Maryland	892	$17.85	$13.18	35
Georgia	873	$14.64	$11.26	40
Tennessee	835	$14.46	$11.56	29
Michigan	817	$14.80	$11.47	44
Kentucky	728	$14.73	$11.18	27
Iowa	609	$14.77	$11.79	29
Arkansas	578	$13.85	$11.36	17
Oklahoma	520	$14.15	$11.34	15
Connecticut	495	$15.48	$11.29	26
Wisconsin	481	$14.19	$11.22	30
Nebraska	469	$14.02	$11.32	20
Minnesota	463	$15.40	$11.90	24
Louisiana	430	$14.23	$11.30	18
Colorado	421	$19.19	$14.58	25
Maine	357	$14.47	$11.11	15
Oregon	338	$14.79	$11.32	18
Alabama	319	$13.84	$11.34	18
Nevada	304	$14.59	$11.20	11
Rhode Island	270	$16.92	$12.19	13
Delaware	264	$14.86	$11.28	12
Mississippi	255	$14.30	$11.32	11
Kansas	253	$14.27	$11.36	9
District of Columbia	243	$15.96	$11.24	12
New Hampshire	224	$14.81	$11.32	11
South Dakota	186	$14.27	$10.86	8
Idaho	177	$14.00	$11.31	10
Utah	102	$14.31	$11.35	6
West Virginia	101	$14.56	$10.88	6
North Dakota	95	$16.66	$12.96	6
Alaska	95	$19.27	$11.26	6
Hawaii	88	$15.11	$11.23	6
Montana	74	$14.61	$11.13	4
Guam	26	$25.28	$18.20	1
New Mexico	15	$14.45	$11.42	1
AP	14	$14.78	$10.00	1
Vermont	11	$15.47	$9.33	1

Related codes

76000Imaging guidance for procedure$27.31
76080Review by radiologist of abscess or sinus cavity study$24.07

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.