How much does Medicare pay for CPT 76536?

Medicare allowed an average of $67.45 per service and paid $48.64 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $242.60, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 76536?

Ultrasound scan of head and neck soft tissue. It was billed 901,656 times to 858,207 Medicare beneficiaries by 14,783 providers in 2024.

Does 76536 pay differently in an office than a hospital?

Yes. The allowed amount averaged $90.99 in an office setting and $26.06 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 76536 most?

Diagnostic Radiology, with 637,113 services from 11,010 clinicians. Next are Endocrinology, Independent Diagnostic Testing Facility (IDTF), Internal Medicine.

CPT 76536

Ultrasound scan of head and neck soft tissue

$67.45Medicare-allowed amount per service, averaged across 901,656 services

Providers submitted

$242.60

Asking price, not received

Medicare allowed

$67.45

The fee schedule figure

Medicare paid

$48.64

Balance is patient coinsurance

Providers submitted an average of $242.60 for this code and Medicare allowed $67.45 — 3.6× 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 $48.64 (72%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $90.99
Hospital / facility: $26.06

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. 574,728 services were billed in an office setting and 326,928 in a facility.

Services: 901,656
Beneficiaries: 858,207
Providers billing it: 14,783
Total allowed: $60,816,697

What Medicare pays for CPT 76536

Across 901,656 services billed by 14,783 providers to 858,207 beneficiaries, Medicare allowed an average of $67.45 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 76536

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	637,113	614,075	$55.68	11,010
Endocrinology	103,392	96,715	$104.36	1,069
Independent Diagnostic Testing Facility (IDTF)	48,335	43,881	$95.76	599
Internal Medicine	27,574	25,388	$105.64	496
Interventional Radiology	22,285	21,480	$56.65	409
Otolaryngology	15,536	13,580	$95.05	278
Family Practice	10,136	9,378	$96.59	294
General Surgery	10,048	9,382	$73.15	180
Nurse Practitioner	4,301	4,022	$84.92	98
Pathology	3,278	3,043	$110.63	18
General Practice	2,425	2,248	$114.79	32
Physician Assistant	2,003	1,926	$78.13	55
Cardiology	1,663	1,607	$112.74	36
Emergency Medicine	1,479	1,401	$95.28	24
Surgical Oncology	1,422	1,209	$50.99	23

76536 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	106,249	$90.42	$57.18	1,573
New York	101,853	$87.65	$55.58	1,035
Florida	72,025	$81.89	$59.72	1,001
Texas	58,699	$67.73	$49.32	1,019
Pennsylvania	37,761	$43.49	$30.09	600
Illinois	36,843	$47.96	$33.09	661
New Jersey	36,090	$92.74	$60.22	500
Maryland	28,205	$89.71	$59.57	299
North Carolina	27,598	$64.65	$49.13	525
Massachusetts	27,352	$47.74	$30.96	381
Virginia	26,540	$59.00	$41.73	384
Ohio	24,198	$40.12	$29.26	412
Tennessee	21,491	$61.54	$47.53	420
Georgia	21,331	$54.69	$40.60	423
Arizona	19,992	$83.81	$59.71	256
Michigan	18,522	$43.86	$31.28	375
Missouri	14,477	$40.88	$30.84	313
South Carolina	14,016	$57.29	$43.94	275
Minnesota	12,570	$55.87	$38.38	319
Washington	12,395	$59.52	$39.83	249
Indiana	12,068	$45.38	$33.62	229
Connecticut	10,516	$69.73	$46.07	189
Wisconsin	10,256	$42.01	$30.04	273
Colorado	9,866	$65.77	$43.83	245
Louisiana	9,530	$51.80	$40.03	213
Alabama	9,177	$53.88	$43.05	242
Oklahoma	9,088	$36.17	$27.38	168
Kentucky	8,871	$45.49	$34.32	193
Nevada	8,857	$81.59	$58.72	158
Kansas	8,029	$56.35	$42.30	134
Delaware	7,937	$53.38	$36.46	42
Oregon	7,125	$50.25	$34.50	179
Iowa	6,942	$46.06	$34.96	143
Arkansas	6,732	$42.67	$33.51	140
Nebraska	6,412	$46.35	$34.66	131
Mississippi	6,046	$56.52	$45.57	123
West Virginia	4,884	$35.01	$24.83	100
New Hampshire	4,798	$38.61	$26.41	96
New Mexico	4,431	$53.52	$37.82	73
Rhode Island	3,896	$69.75	$47.50	57
Utah	3,676	$51.92	$38.07	105
Hawaii	2,946	$74.02	$49.38	43
District of Columbia	2,811	$88.82	$56.63	45
North Dakota	2,721	$36.13	$24.96	52
Idaho	2,581	$41.16	$29.17	58
South Dakota	2,337	$32.80	$22.85	45
Maine	2,230	$32.81	$22.79	68
Vermont	1,797	$35.51	$23.64	33
Alaska	1,699	$74.18	$45.39	31
Montana	1,626	$32.18	$22.49	55
Wyoming	1,373	$63.49	$45.30	30
Puerto Rico	1,299	$94.20	$63.90	53
AP	291	$60.77	$38.08	3
Guam	272	$102.65	$60.97	7
XX	142	$109.20	$72.91	2
ZZ	87	$26.17	$18.24	2

Related codes

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
76516Ultrasound scan to determine eye length$42.51

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.