How much does Medicare pay for CPT 76856?

Medicare allowed an average of $80.52 per service and paid $59.97 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $294.10, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 76856?

Complete ultrasound scan of pelvis. It was billed 266,828 times to 239,510 Medicare beneficiaries by 6,352 providers in 2024.

Does 76856 pay differently in an office than a hospital?

Yes. The allowed amount averaged $94.38 in an office setting and $32.12 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 76856 most?

Diagnostic Radiology, with 137,045 services from 4,302 clinicians. Next are Urology, Obstetrics & Gynecology, Independent Diagnostic Testing Facility (IDTF).

CPT 76856

Complete ultrasound scan of pelvis

$80.52Medicare-allowed amount per service, averaged across 266,828 services

Providers submitted

$294.10

Asking price, not received

Medicare allowed

$80.52

The fee schedule figure

Medicare paid

$59.97

Balance is patient coinsurance

Providers submitted an average of $294.10 for this code and Medicare allowed $80.52 — 3.7× 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 $59.97 (74%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $94.38
Hospital / facility: $32.12

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. 207,420 services were billed in an office setting and 59,408 in a facility.

Services: 266,828
Beneficiaries: 239,510
Providers billing it: 6,352
Total allowed: $21,484,991

What Medicare pays for CPT 76856

Across 266,828 services billed by 6,352 providers to 239,510 beneficiaries, Medicare allowed an average of $80.52 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 76856

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	137,045	130,759	$63.59	4,302
Urology	63,994	50,067	$105.93	440
Obstetrics & Gynecology	33,675	30,544	$102.57	855
Independent Diagnostic Testing Facility (IDTF)	17,361	14,378	$75.86	326
Internal Medicine	3,734	3,532	$96.43	105
Interventional Radiology	3,504	3,362	$62.84	122
Family Practice	2,490	2,288	$84.14	60
Nurse Practitioner	996	947	$87.24	25
Nuclear Medicine	497	478	$59.08	16
Physician Assistant	469	436	$76.76	15
Gynecological Oncology	381	335	$112.66	11
Nephrology	371	233	$72.54	5
General Practice	310	292	$107.94	10
Portable X-Ray Supplier	273	205	$66.25	5
Cardiology	220	214	$106.69	8

76856 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	62,253	$93.74	$60.46	1,076
New York	46,210	$94.10	$61.49	720
Florida	21,894	$86.22	$64.41	441
New Jersey	18,344	$98.73	$64.85	399
Maryland	15,338	$90.63	$61.58	272
Massachusetts	11,403	$57.35	$37.99	277
Pennsylvania	9,333	$53.24	$37.61	257
Illinois	9,001	$66.79	$47.80	298
Texas	8,030	$68.35	$51.36	280
Arizona	5,515	$86.04	$63.36	151
Michigan	5,022	$47.48	$35.24	185
Virginia	4,542	$62.44	$44.76	123
Minnesota	3,497	$60.76	$43.25	160
Ohio	3,396	$49.97	$37.08	106
Washington	3,372	$60.57	$40.73	118
Tennessee	3,034	$67.03	$52.96	79
North Carolina	2,441	$57.40	$42.02	67
Connecticut	2,144	$70.70	$47.05	63
Georgia	2,076	$63.10	$48.18	61
Missouri	2,068	$43.18	$32.70	88
Delaware	2,015	$61.02	$43.33	43
Oregon	1,796	$49.23	$34.86	84
Wisconsin	1,624	$41.31	$30.20	76
Indiana	1,518	$44.97	$33.28	71
Rhode Island	1,386	$67.71	$46.81	40
Colorado	1,357	$77.23	$53.61	65
Kansas	1,296	$48.36	$36.66	50
Nevada	1,277	$69.30	$49.60	49
South Carolina	1,246	$60.35	$47.70	59
New Mexico	1,187	$63.75	$47.80	39
Louisiana	1,180	$63.86	$49.43	52
District of Columbia	1,156	$84.93	$56.29	33
Mississippi	1,153	$69.30	$58.31	37
Oklahoma	1,002	$46.79	$36.25	41
Arkansas	833	$43.70	$35.10	40
Alabama	805	$47.38	$38.09	39
Hawaii	784	$80.06	$52.45	22
Nebraska	753	$48.86	$34.99	34
Iowa	656	$52.20	$39.97	26
New Hampshire	636	$64.58	$45.76	23
Utah	545	$44.32	$32.40	32
North Dakota	535	$38.81	$27.47	21
Kentucky	525	$46.43	$34.81	25
Puerto Rico	491	$78.36	$54.65	25
Maine	387	$40.08	$26.03	18
Montana	387	$51.02	$36.98	22
Alaska	306	$64.63	$39.77	11
Vermont	272	$38.73	$28.01	13
Idaho	245	$51.54	$37.45	12
South Dakota	219	$34.66	$23.90	7
West Virginia	187	$56.71	$44.74	11
Wyoming	84	$47.55	$35.75	6
U.S. Virgin Islands	32	$103.17	$70.94	2
XX	29	$78.77	$52.22	2
AP	11	$118.13	$79.11	1

Related codes

76830Ultrasound scan of uterus$88.51
76882Limited ultrasound scan of joint or other extremity structure except b$47.73
76872Ultrasound scan of pelvic region through rectum$93.36
76881Complete ultrasound scan of joint$51.91
76857Limited ultrasound scan of pelvis$43.46
76870Ultrasound scan of scrotum$55.05
76883Comprehensive ultrasound scan of entire length of nerves in extremity$67.00
76873Ultrasound scan of prostate through rectum$129.46
76800Ultrasound scan of spinal canal$160.15

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.