How much does Medicare pay for CPT 76641?

Medicare allowed an average of $97.75 per service and paid $69.33 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $453.04, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 76641?

Complete ultrasound scan of 1 breast. It was billed 380,001 times to 359,850 Medicare beneficiaries by 4,020 providers in 2024.

Does 76641 pay differently in an office than a hospital?

Yes. The allowed amount averaged $121.97 in an office setting and $47.56 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 76641 most?

Diagnostic Radiology, with 341,781 services from 3,570 clinicians. Next are Independent Diagnostic Testing Facility (IDTF), General Surgery, Obstetrics & Gynecology.

CPT 76641

Complete ultrasound scan of 1 breast

$97.75Medicare-allowed amount per service, averaged across 380,001 services

Providers submitted

$453.04

Asking price, not received

Medicare allowed

$97.75

The fee schedule figure

Medicare paid

$69.33

Balance is patient coinsurance

Providers submitted an average of $453.04 for this code and Medicare allowed $97.75 — 4.6× 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 $69.33 (71%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $121.97
Hospital / facility: $47.56

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. 256,287 services were billed in an office setting and 123,714 in a facility.

Services: 380,001
Beneficiaries: 359,850
Providers billing it: 4,020
Total allowed: $37,145,098

What Medicare pays for CPT 76641

Across 380,001 services billed by 4,020 providers to 359,850 beneficiaries, Medicare allowed an average of $97.75 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 76641

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	341,781	325,413	$94.88	3,570
Independent Diagnostic Testing Facility (IDTF)	12,236	11,410	$124.87	138
General Surgery	11,654	9,881	$130.24	66
Obstetrics & Gynecology	5,132	4,819	$115.28	120
Surgical Oncology	2,392	2,149	$138.76	10
Interventional Radiology	1,885	1,832	$100.63	30
Internal Medicine	1,725	1,357	$111.77	27
Nurse Practitioner	749	737	$123.11	14
Family Practice	726	678	$99.38	20
Dermatology	456	441	$104.59	2
Anesthesiology	409	363	$150.76	2
General Practice	185	108	$99.76	3
Mammography Center	164	164	$116.40	1
Radiation Oncology	144	141	$75.72	2
Cardiology	102	99	$132.78	3

76641 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 York	86,370	$108.90	$68.26	611
Florida	57,023	$98.85	$69.63	409
California	47,553	$104.80	$65.78	478
New Jersey	31,542	$107.20	$66.30	266
Texas	26,471	$71.79	$50.25	312
Pennsylvania	15,094	$70.49	$47.12	171
Connecticut	10,856	$96.03	$61.35	132
Arizona	8,734	$116.45	$84.46	79
Georgia	8,719	$118.84	$87.13	95
Illinois	7,767	$96.69	$61.63	133
Tennessee	7,449	$97.56	$69.68	87
Virginia	4,787	$72.07	$49.87	97
Nevada	3,996	$114.69	$78.81	50
Massachusetts	3,923	$84.86	$55.69	39
North Carolina	3,681	$94.13	$63.49	58
Alabama	3,593	$67.37	$50.32	63
New Mexico	3,461	$104.75	$73.80	29
Puerto Rico	3,436	$101.85	$82.41	61
Louisiana	3,269	$84.62	$63.92	39
Ohio	3,170	$69.95	$48.08	71
Michigan	3,024	$75.65	$51.20	70
Washington	2,867	$96.36	$61.77	42
Colorado	2,833	$119.08	$76.92	37
Missouri	2,721	$94.35	$64.31	52
Maryland	2,440	$106.57	$70.86	65
Arkansas	2,263	$78.29	$57.76	35
Mississippi	2,032	$63.41	$47.34	38
Indiana	2,014	$75.91	$51.01	27
South Carolina	1,955	$66.46	$48.83	35
Iowa	1,828	$74.75	$51.10	31
Kansas	1,496	$59.67	$40.18	26
District of Columbia	1,468	$85.03	$56.05	26
Rhode Island	1,448	$71.84	$44.80	27
Oregon	1,380	$81.23	$56.91	38
Hawaii	1,191	$132.93	$85.03	12
Minnesota	1,178	$72.46	$50.36	23
Oklahoma	1,166	$49.24	$34.37	23
Delaware	796	$87.41	$59.22	20
Vermont	747	$62.81	$43.37	12
Wisconsin	728	$85.52	$64.01	11
West Virginia	674	$73.34	$52.77	13
Guam	567	$123.44	$72.84	5
Montana	555	$86.29	$59.67	15
Kentucky	401	$53.70	$38.53	14
Nebraska	307	$33.66	$23.92	11
Maine	230	$46.96	$30.34	7
Wyoming	209	$70.80	$49.47	5
New Hampshire	203	$46.09	$32.91	4
Utah	108	$109.03	$82.81	4
Idaho	93	$75.02	$59.13	4
U.S. Virgin Islands	82	$95.36	$58.94	2
North Dakota	35	$33.13	$24.89	2
Alaska	26	$72.14	$48.14	2
AP	25	$171.92	$103.32	1
South Dakota	17	$36.25	$26.83	1

Related codes

76642Limited ultrasound scan of 1 breast$50.91
76604Ultrasound scan of chest$29.85

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.