How much does Medicare pay for CPT 76870?

Medicare allowed an average of $55.05 per service and paid $40.53 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $218.90, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 76870?

Ultrasound scan of scrotum. It was billed 48,654 times to 45,531 Medicare beneficiaries by 2,336 providers in 2024.

Does 76870 pay differently in an office than a hospital?

Yes. The allowed amount averaged $78.29 in an office setting and $29.23 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 76870 most?

Diagnostic Radiology, with 34,342 services from 1,852 clinicians. Next are Urology, Independent Diagnostic Testing Facility (IDTF), Interventional Radiology.

CPT 76870

Ultrasound scan of scrotum

$55.05Medicare-allowed amount per service, averaged across 48,654 services

Providers submitted

$218.90

Asking price, not received

Medicare allowed

$55.05

The fee schedule figure

Medicare paid

$40.53

Balance is patient coinsurance

Providers submitted an average of $218.90 for this code and Medicare allowed $55.05 — 4.0× 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 $40.53 (74%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $78.29
Hospital / facility: $29.23

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. 25,606 services were billed in an office setting and 23,048 in a facility.

Services: 48,654
Beneficiaries: 45,531
Providers billing it: 2,336
Total allowed: $2,678,403

What Medicare pays for CPT 76870

Across 48,654 services billed by 2,336 providers to 45,531 beneficiaries, Medicare allowed an average of $55.05 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 76870

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	34,342	33,267	$44.56	1,852
Urology	7,605	6,575	$93.29	237
Independent Diagnostic Testing Facility (IDTF)	4,720	3,830	$68.94	152
Interventional Radiology	1,187	1,158	$49.63	59
Portable X-Ray Supplier	161	96	$55.76	4
Family Practice	157	144	$74.05	6
Internal Medicine	139	130	$72.50	4
Nurse Practitioner	57	51	$65.31	4
Physician Assistant	52	51	$67.08	4
Endocrinology	46	42	$89.28	1
Nuclear Medicine	41	41	$31.80	3
Radiation Oncology	31	30	$65.74	2
Pediatric Medicine	24	24	$76.87	2
Emergency Medicine	23	23	$70.09	2
Cardiology	22	22	$115.67	1

76870 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	6,432	$67.70	$44.30	280
New York	5,583	$79.16	$52.98	183
Florida	4,048	$64.01	$47.58	182
Texas	2,478	$55.62	$40.62	139
Massachusetts	1,761	$46.61	$30.58	93
Illinois	1,757	$45.47	$33.11	93
Maryland	1,740	$66.82	$46.71	68
Pennsylvania	1,722	$37.19	$25.92	97
Virginia	1,588	$54.72	$40.06	67
Ohio	1,582	$32.36	$23.71	82
New Jersey	1,419	$74.82	$54.84	57
North Carolina	1,368	$48.61	$36.65	63
Arizona	1,242	$68.96	$51.32	62
Michigan	1,093	$36.59	$26.56	51
Tennessee	1,076	$50.14	$39.08	51
Georgia	1,049	$51.73	$39.10	59
Missouri	1,016	$36.42	$27.44	56
South Carolina	908	$43.36	$32.70	46
Washington	830	$44.19	$28.84	43
Minnesota	744	$42.33	$30.89	50
Colorado	719	$47.66	$32.98	40
Indiana	664	$37.23	$28.62	37
Arkansas	655	$34.17	$26.22	30
Oklahoma	564	$30.98	$22.53	29
Connecticut	438	$42.57	$29.05	18
Kentucky	436	$38.77	$29.98	21
Mississippi	431	$33.17	$26.08	27
Kansas	404	$46.12	$33.53	22
Delaware	394	$57.92	$41.00	16
Louisiana	391	$47.34	$35.22	22
Alabama	372	$36.88	$27.68	22
Iowa	354	$42.30	$30.89	23
Nevada	349	$64.87	$45.18	19
Oregon	315	$32.60	$23.45	22
New Hampshire	284	$31.11	$20.47	17
Wisconsin	271	$34.52	$23.57	18
Nebraska	256	$35.66	$25.99	15
New Mexico	220	$45.03	$34.12	10
West Virginia	214	$31.65	$22.00	14
South Dakota	193	$30.96	$19.63	11
Utah	183	$35.77	$26.48	12
Idaho	148	$27.97	$19.31	9
North Dakota	136	$39.03	$27.24	7
Vermont	132	$28.46	$19.90	9
District of Columbia	120	$43.08	$28.95	7
Rhode Island	104	$57.38	$41.09	8
Alaska	104	$56.43	$32.41	5
Hawaii	104	$66.02	$45.98	5
Montana	89	$28.67	$20.63	7
Maine	76	$28.86	$18.86	6
Wyoming	45	$41.62	$29.89	3
ZZ	31	$30.69	$21.89	1
Puerto Rico	11	$65.07	$53.59	1
AA	11	$28.81	$20.30	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
76857Limited ultrasound scan of pelvis$43.46
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.