How much does Medicare pay for CPT 76857?

Medicare allowed an average of $43.46 per service and paid $32.36 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $212.44, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 76857?

Limited ultrasound scan of pelvis. It was billed 139,297 times to 114,120 Medicare beneficiaries by 2,585 providers in 2024.

Does 76857 pay differently in an office than a hospital?

Yes. The allowed amount averaged $47.21 in an office setting and $22.93 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 76857 most?

Urology, with 79,984 services from 567 clinicians. Next are Diagnostic Radiology, Independent Diagnostic Testing Facility (IDTF), Obstetrics & Gynecology.

CPT 76857

Limited ultrasound scan of pelvis

$43.46Medicare-allowed amount per service, averaged across 139,297 services

Providers submitted

$212.44

Asking price, not received

Medicare allowed

$43.46

The fee schedule figure

Medicare paid

$32.36

Balance is patient coinsurance

Providers submitted an average of $212.44 for this code and Medicare allowed $43.46 — 4.9× 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 $32.36 (74%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $47.21
Hospital / facility: $22.93

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. 117,741 services were billed in an office setting and 21,556 in a facility.

Services: 139,297
Beneficiaries: 114,120
Providers billing it: 2,585
Total allowed: $6,053,848

What Medicare pays for CPT 76857

Across 139,297 services billed by 2,585 providers to 114,120 beneficiaries, Medicare allowed an average of $43.46 per service. That is 1.2 services per beneficiary, so this is a code patients typically receive more than once. 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 76857

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	79,984	60,653	$50.31	567
Diagnostic Radiology	36,072	34,709	$30.31	1,546
Independent Diagnostic Testing Facility (IDTF)	7,709	6,155	$32.31	116
Obstetrics & Gynecology	5,223	4,358	$48.93	142
Nurse Practitioner	2,674	2,128	$40.80	27
Internal Medicine	2,105	1,340	$51.09	30
Interventional Radiology	1,219	1,160	$31.22	45
Physician Assistant	926	831	$38.42	29
Family Practice	610	461	$48.50	16
Emergency Medicine	574	566	$23.76	30
General Practice	543	376	$51.22	5
General Surgery	436	334	$53.92	5
Hematology-Oncology	256	256	$34.88	4
Portable X-Ray Supplier	208	128	$25.75	4
Gastroenterology	204	200	$49.22	3

76857 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	28,779	$49.53	$32.35	392
New York	23,159	$47.63	$31.50	289
New Jersey	22,514	$49.53	$33.07	204
Florida	16,330	$40.78	$30.27	285
Texas	5,157	$36.85	$26.94	156
Maryland	4,841	$43.06	$29.74	89
Pennsylvania	3,924	$36.55	$25.47	117
Mississippi	3,743	$39.40	$34.14	10
Massachusetts	3,304	$29.70	$20.78	103
Arizona	3,132	$43.53	$32.45	72
Virginia	2,771	$37.12	$27.39	56
Illinois	2,084	$32.08	$23.16	63
Ohio	1,856	$26.02	$19.47	83
Michigan	1,723	$35.08	$26.07	58
Georgia	1,498	$42.66	$31.02	27
Connecticut	1,278	$39.33	$24.91	41
Tennessee	1,230	$35.90	$28.51	20
Washington	1,064	$37.42	$25.34	40
Colorado	870	$29.94	$21.96	40
North Carolina	753	$34.83	$25.94	22
Nevada	596	$38.83	$27.98	23
Oregon	595	$22.83	$16.44	30
Missouri	581	$27.04	$20.49	27
Minnesota	540	$29.31	$20.25	22
Kentucky	537	$33.00	$25.89	25
Louisiana	445	$32.77	$27.00	21
New Mexico	444	$32.20	$22.47	13
Iowa	399	$28.67	$21.97	22
Oklahoma	398	$23.92	$18.57	19
Nebraska	393	$26.63	$20.90	18
Wisconsin	376	$30.15	$21.58	18
West Virginia	349	$31.59	$24.00	16
Kansas	348	$32.79	$25.10	17
South Carolina	345	$36.35	$29.19	9
Indiana	335	$27.35	$20.45	17
Hawaii	295	$44.10	$31.12	9
District of Columbia	285	$34.09	$22.59	14
Idaho	245	$24.29	$18.06	11
Arkansas	208	$31.88	$26.60	8
Utah	196	$43.16	$32.85	8
Alabama	182	$32.88	$26.29	8
Rhode Island	180	$33.12	$23.52	10
North Dakota	166	$22.97	$15.75	8
New Hampshire	161	$27.92	$20.10	9
Puerto Rico	141	$48.32	$35.96	3
Vermont	93	$33.54	$22.63	6
Delaware	93	$40.49	$26.52	4
South Dakota	89	$29.58	$20.95	6
Maine	76	$22.68	$14.56	6
Alaska	69	$38.18	$23.74	4
Montana	45	$33.81	$25.53	3
Wyoming	41	$32.47	$21.60	2
U.S. Virgin Islands	29	$51.04	$33.10	1
ZZ	12	$23.74	$17.67	1

Related codes

76856Complete ultrasound scan of pelvis$80.52
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
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.