How much does Medicare pay for CPT 76499?

Medicare allowed an average of $49.56 per service and paid $39.19 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $208.21, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 76499?

Other diagnostic imaging procedure. It was billed 1,564 times to 1,535 Medicare beneficiaries by 34 providers in 2024.

Does 76499 pay differently in an office than a hospital?

Yes. The allowed amount averaged $26.65 in an office setting and $54.63 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 76499 most?

Diagnostic Radiology, with 1,302 services from 27 clinicians. Next are Cardiac Surgery, Thoracic Surgery.

CPT 76499

Other diagnostic imaging procedure

$49.56Medicare-allowed amount per service, averaged across 1,564 services

Providers submitted

$208.21

Asking price, not received

Medicare allowed

$49.56

The fee schedule figure

Medicare paid

$39.19

Balance is patient coinsurance

Providers submitted an average of $208.21 for this code and Medicare allowed $49.56 — 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 $39.19 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $26.65
Hospital / facility: $54.63

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 283 services were billed in an office setting and 1,281 in a facility.

Services: 1,564
Beneficiaries: 1,535
Providers billing it: 34
Total allowed: $77,512

What Medicare pays for CPT 76499

Across 1,564 services billed by 34 providers to 1,535 beneficiaries, Medicare allowed an average of $49.56 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 76499

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	1,302	1,273	$18.63	27
Cardiac Surgery	204	204	$202.37	5
Thoracic Surgery	58	58	$206.62	2

76499 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
New Hampshire	1,110	$16.02	$12.24	14
Virginia	262	$203.31	$156.66	7
Massachusetts	56	$23.22	$18.22	4
New York	36	$46.55	$32.55	3
Colorado	31	$50.95	$39.92	2
Illinois	27	$16.09	$12.82	1
Maryland	18	$28.43	$22.65	1
Florida	13	$61.46	$45.39	1
Missouri	11	$14.87	$11.84	1

Related codes

76498Other mri scan$54.47

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.