How much does Medicare pay for CPT 76604?

Medicare allowed an average of $29.85 per service and paid $23.33 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $187.19, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 76604?

Ultrasound scan of chest. It was billed 62,928 times to 55,915 Medicare beneficiaries by 2,142 providers in 2024.

Does 76604 pay differently in an office than a hospital?

Yes. The allowed amount averaged $50.60 in an office setting and $26.54 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 76604 most?

Diagnostic Radiology, with 26,961 services from 1,000 clinicians. Next are Emergency Medicine, Pulmonary Disease, Critical Care (Intensivists).

CPT 76604

Ultrasound scan of chest

$29.85Medicare-allowed amount per service, averaged across 62,928 services

Providers submitted

$187.19

Asking price, not received

Medicare allowed

$29.85

The fee schedule figure

Medicare paid

$23.33

Balance is patient coinsurance

Providers submitted an average of $187.19 for this code and Medicare allowed $29.85 — 6.3× 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 $23.33 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $50.60
Hospital / facility: $26.54

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. 8,659 services were billed in an office setting and 54,269 in a facility.

Services: 62,928
Beneficiaries: 55,915
Providers billing it: 2,142
Total allowed: $1,878,401

What Medicare pays for CPT 76604

Across 62,928 services billed by 2,142 providers to 55,915 beneficiaries, Medicare allowed an average of $29.85 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 76604

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	26,961	25,332	$26.96	1,000
Emergency Medicine	11,398	11,289	$26.57	509
Pulmonary Disease	9,218	6,434	$38.88	203
Critical Care (Intensivists)	3,137	2,639	$31.99	75
General Surgery	2,352	2,224	$28.98	55
Interventional Radiology	2,001	1,838	$26.28	78
Physician Assistant	1,688	1,221	$26.60	56
Internal Medicine	1,650	1,358	$33.66	53
Independent Diagnostic Testing Facility (IDTF)	1,290	926	$35.04	25
Nurse Practitioner	1,012	935	$34.04	31
Hospitalist	364	328	$26.53	16
Portable X-Ray Supplier	248	144	$29.95	3
Pain Management	228	193	$60.23	1
Nephrology	215	77	$47.59	4
Cardiology	198	194	$61.25	4

76604 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	13,882	$31.22	$22.00	460
New York	8,045	$36.94	$25.21	178
Florida	6,136	$28.31	$20.92	215
Texas	5,965	$28.25	$21.05	159
Massachusetts	2,855	$26.85	$19.78	121
Pennsylvania	2,403	$26.52	$20.17	94
Minnesota	1,950	$25.59	$19.27	57
Arizona	1,752	$28.15	$21.49	60
Nevada	1,718	$26.47	$20.71	38
Ohio	1,373	$25.83	$20.25	59
Illinois	1,371	$29.29	$21.80	60
New Jersey	1,198	$31.27	$22.60	48
Maryland	1,156	$31.69	$23.97	37
South Carolina	1,106	$27.16	$21.55	30
Connecticut	1,024	$29.07	$21.01	39
Arkansas	1,000	$25.49	$21.09	37
Missouri	954	$25.45	$19.81	30
Michigan	920	$27.43	$20.48	49
Georgia	773	$25.81	$19.64	31
Indiana	714	$27.73	$21.64	31
Alabama	502	$32.78	$26.89	24
Tennessee	478	$34.15	$27.26	23
Mississippi	399	$27.82	$22.66	18
Washington	367	$35.57	$25.99	13
Nebraska	349	$26.93	$20.91	13
Virginia	348	$33.03	$24.37	15
Oklahoma	347	$24.53	$19.40	17
Delaware	327	$24.50	$20.77	12
North Carolina	314	$27.29	$21.63	16
Louisiana	313	$26.84	$22.43	14
Colorado	279	$25.98	$19.00	16
Maine	263	$26.69	$19.89	16
Wisconsin	257	$28.81	$22.58	13
District of Columbia	213	$26.95	$18.72	8
West Virginia	164	$26.34	$17.45	7
Kansas	160	$33.18	$24.25	7
New Hampshire	146	$25.50	$19.45	6
Rhode Island	146	$27.36	$19.80	9
Hawaii	140	$47.82	$33.47	5
Oregon	138	$26.44	$18.78	9
Montana	134	$25.82	$19.64	4
Iowa	115	$29.24	$22.10	8
Idaho	104	$25.61	$20.27	4
Vermont	100	$25.05	$19.40	7
Utah	95	$26.55	$19.46	5
South Dakota	92	$25.43	$19.17	4
Alaska	90	$48.24	$28.36	6
Kentucky	89	$25.90	$20.01	4
Puerto Rico	58	$54.41	$44.03	1
New Mexico	51	$33.64	$25.52	3
Wyoming	43	$25.95	$20.36	1
North Dakota	12	$25.58	$20.16	1

Related codes

76642Limited ultrasound scan of 1 breast$50.91
76641Complete ultrasound scan of 1 breast$97.75

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.