How much does Medicare pay for CPT 76642?

Medicare allowed an average of $50.91 per service and paid $36.17 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $217.11, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 76642?

Limited ultrasound scan of 1 breast. It was billed 634,205 times to 604,762 Medicare beneficiaries by 8,780 providers in 2024.

Does 76642 pay differently in an office than a hospital?

Yes. The allowed amount averaged $70.65 in an office setting and $33.35 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 76642 most?

Diagnostic Radiology, with 590,887 services from 8,039 clinicians. Next are Independent Diagnostic Testing Facility (IDTF), General Surgery, Interventional Radiology.

CPT 76642

Limited ultrasound scan of 1 breast

$50.91Medicare-allowed amount per service, averaged across 634,205 services

Providers submitted

$217.11

Asking price, not received

Medicare allowed

$50.91

The fee schedule figure

Medicare paid

$36.17

Balance is patient coinsurance

Providers submitted an average of $217.11 for this code and Medicare allowed $50.91 — 4.3× 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 $36.17 (71%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $70.65
Hospital / facility: $33.35

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. 298,483 services were billed in an office setting and 335,722 in a facility.

Services: 634,205
Beneficiaries: 604,762
Providers billing it: 8,780
Total allowed: $32,287,377

What Medicare pays for CPT 76642

Across 634,205 services billed by 8,780 providers to 604,762 beneficiaries, Medicare allowed an average of $50.91 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 76642

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	590,887	566,782	$49.48	8,039
Independent Diagnostic Testing Facility (IDTF)	14,530	13,018	$71.88	160
General Surgery	13,000	10,806	$80.42	219
Interventional Radiology	4,496	4,362	$51.05	85
Obstetrics & Gynecology	2,473	2,087	$65.85	83
Surgical Oncology	2,393	1,935	$80.21	52
Family Practice	1,348	1,122	$54.56	34
Internal Medicine	1,315	1,155	$56.38	28
Radiation Oncology	760	704	$52.09	8
Nurse Practitioner	540	482	$70.01	19
Nuclear Medicine	468	467	$67.25	7
Emergency Medicine	446	436	$48.40	13
Rheumatology	434	380	$48.23	1
Hematology-Oncology	195	178	$85.68	10
Pediatric Medicine	191	176	$59.60	2

76642 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	65,113	$63.82	$40.18	745
Florida	39,918	$61.99	$44.02	499
New York	34,939	$61.10	$38.63	539
Illinois	32,519	$42.04	$28.09	415
Pennsylvania	30,590	$39.05	$26.24	404
Texas	29,314	$48.70	$34.56	451
New Jersey	24,956	$70.38	$44.98	302
Massachusetts	23,022	$41.74	$26.92	295
North Carolina	22,978	$51.06	$37.04	346
Virginia	21,379	$49.31	$34.66	262
Ohio	20,994	$35.38	$24.47	310
Maryland	20,209	$74.98	$49.89	170
Georgia	18,475	$47.17	$33.52	277
Tennessee	16,315	$46.47	$34.24	269
Michigan	16,194	$38.21	$25.55	245
Washington	15,829	$53.85	$36.01	169
Missouri	15,289	$36.52	$25.24	212
Arizona	13,231	$65.43	$47.01	133
Minnesota	12,341	$49.62	$34.81	215
Indiana	11,391	$37.52	$26.56	156
Colorado	10,314	$59.54	$38.73	133
South Carolina	10,276	$39.71	$28.99	128
Wisconsin	9,035	$40.88	$28.67	221
Oklahoma	8,148	$36.66	$26.56	88
Oregon	7,702	$41.64	$29.12	111
Kentucky	7,676	$38.96	$27.51	117
Connecticut	7,256	$53.42	$35.03	139
Arkansas	7,234	$50.19	$39.33	86
Iowa	7,039	$48.43	$35.24	112
Louisiana	6,837	$38.43	$27.71	143
Alabama	6,664	$41.55	$31.15	137
Kansas	6,206	$45.42	$32.72	91
Mississippi	5,352	$39.51	$30.17	86
Nebraska	5,008	$40.19	$29.09	74
District of Columbia	4,520	$62.67	$40.91	44
Rhode Island	3,888	$54.98	$36.36	40
Nevada	3,582	$65.04	$45.04	50
Delaware	3,297	$53.62	$37.00	32
New Mexico	3,218	$53.37	$38.17	46
Maine	2,907	$34.62	$22.13	61
Utah	2,808	$38.83	$27.35	57
New Hampshire	2,665	$40.15	$27.78	52
North Dakota	2,652	$33.75	$22.95	37
Idaho	2,505	$37.38	$26.76	42
West Virginia	2,318	$34.81	$23.64	61
South Dakota	2,210	$41.67	$28.48	38
Hawaii	1,851	$49.69	$32.35	33
Montana	1,671	$42.11	$28.22	31
Vermont	1,625	$35.68	$24.08	28
Alaska	1,304	$54.70	$33.72	22
Wyoming	1,207	$59.82	$43.06	23
AP	203	$63.38	$37.46	2
AA	31	$31.40	$22.91	1

Related codes

76641Complete ultrasound scan of 1 breast$97.75
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.