How much does Medicare pay for CPT 76498?

Medicare allowed an average of $54.47 per service and paid $43.27 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $409.52, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 76498?

Other mri scan. It was billed 5,743 times to 5,190 Medicare beneficiaries by 150 providers in 2024.

Does 76498 pay differently in an office than a hospital?

Yes. The allowed amount averaged $41.07 in an office setting and $76.94 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 76498 most?

Diagnostic Radiology, with 4,601 services from 119 clinicians. Next are Radiation Oncology, Urology, Ambulatory Surgical Center.

CPT 76498

Other mri scan

$54.47Medicare-allowed amount per service, averaged across 5,743 services

Providers submitted

$409.52

Asking price, not received

Medicare allowed

$54.47

The fee schedule figure

Medicare paid

$43.27

Balance is patient coinsurance

Providers submitted an average of $409.52 for this code and Medicare allowed $54.47 — 7.5× 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 $43.27 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $41.07
Hospital / facility: $76.94

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 3,598 services were billed in an office setting and 2,145 in a facility.

Services: 5,743
Beneficiaries: 5,190
Providers billing it: 150
Total allowed: $312,821

What Medicare pays for CPT 76498

Across 5,743 services billed by 150 providers to 5,190 beneficiaries, Medicare allowed an average of $54.47 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 76498

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	4,601	4,492	$35.31	119
Radiation Oncology	586	145	$205.95	8
Urology	329	329	$57.07	17
Ambulatory Surgical Center	137	137	$45.24	5
Interventional Radiology	90	87	$52.32	1

76498 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
Maryland	1,104	$38.05	$29.83	21
Florida	803	$42.04	$32.13	13
Pennsylvania	723	$81.06	$64.47	19
Texas	568	$37.10	$30.00	16
New York	412	$68.36	$50.59	11
Delaware	284	$19.12	$15.11	4
Louisiana	282	$82.72	$65.88	6
Iowa	256	$204.22	$162.73	6
New Jersey	207	$34.49	$27.46	9
Michigan	202	$10.76	$8.42	6
Nebraska	150	$29.99	$23.89	4
Missouri	103	$27.51	$21.81	4
Washington	97	$52.56	$40.90	4
North Carolina	81	$29.47	$23.46	3
California	76	$72.17	$56.85	4
District of Columbia	45	$34.76	$27.69	1
Indiana	44	$9.94	$7.97	2
Tennessee	37	$31.76	$22.92	2
Idaho	34	$43.23	$34.44	1
Oklahoma	34	$246.31	$189.49	2
Colorado	32	$9.29	$7.40	2
Minnesota	32	$27.39	$21.26	1
Illinois	23	$35.56	$28.26	2
Georgia	23	$27.70	$22.07	1
Ohio	23	$26.41	$19.71	1
Alabama	18	$9.19	$7.32	1
South Carolina	13	$9.19	$7.32	1
Mississippi	13	$17.29	$13.73	1
Virginia	13	$70.97	$56.23	1
Vermont	11	$78.67	$63.17	1

Related codes

76499Other diagnostic imaging procedure$49.56

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.