How much does Medicare pay for CPT 76516?

Medicare allowed an average of $42.51 per service and paid $32.41 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $163.01, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 76516?

Ultrasound scan to determine eye length. It was billed 1,266 times to 1,157 Medicare beneficiaries by 31 providers in 2024.

Does 76516 pay differently in an office than a hospital?

Yes. The allowed amount averaged $45.54 in an office setting and $23.27 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 76516 most?

Ophthalmology, with 1,227 services from 29 clinicians. Next are Optometry.

CPT 76516

Ultrasound scan to determine eye length

$42.51Medicare-allowed amount per service, averaged across 1,266 services

Providers submitted

$163.01

Asking price, not received

Medicare allowed

$42.51

The fee schedule figure

Medicare paid

$32.41

Balance is patient coinsurance

Providers submitted an average of $163.01 for this code and Medicare allowed $42.51 — 3.8× 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 $32.41 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $45.54
Hospital / facility: $23.27

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. 1,094 services were billed in an office setting and 172 in a facility.

Services: 1,266
Beneficiaries: 1,157
Providers billing it: 31
Total allowed: $53,818

What Medicare pays for CPT 76516

Across 1,266 services billed by 31 providers to 1,157 beneficiaries, Medicare allowed an average of $42.51 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 76516

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	1,227	1,119	$42.40	29
Optometry	39	38	$46.06	2

76516 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	342	$56.70	$35.25	5
Missouri	223	$33.83	$30.09	1
Massachusetts	166	$23.59	$16.31	3
New Jersey	88	$49.28	$33.50	2
Michigan	87	$28.79	$22.02	6
Texas	64	$43.78	$31.52	1
New York	57	$52.14	$34.51	2
Tennessee	42	$29.93	$23.52	2
Arizona	41	$44.72	$33.72	1
Connecticut	37	$49.10	$31.08	2
Georgia	29	$41.00	$30.41	1
Maryland	27	$48.15	$33.74	2
Pennsylvania	27	$48.21	$32.46	1
Colorado	23	$46.91	$36.54	1
Oregon	13	$44.09	$33.63	1

Related codes

76536Ultrasound scan of head and neck soft tissue$67.45
76514Ultrasound scan of cornea to determine thickness$10.70
765122d ultrasound scan of eye tissue and structures$52.75
76519Ultrasound scan to determine eye length and lens power$49.07
765101d and 2d ultrasound scan of eye tissue and structures$64.45
76513Ultrasound scan of eye$96.62
765111d ultrasound scan of eye tissue and structures$57.36

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.