How much does Medicare pay for CPT 76872?

Medicare allowed an average of $93.36 per service and paid $72.87 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $407.25, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 76872?

Ultrasound scan of pelvic region through rectum. It was billed 208,791 times to 200,554 Medicare beneficiaries by 4,609 providers in 2024.

Does 76872 pay differently in an office than a hospital?

Yes. The allowed amount averaged $133.54 in an office setting and $38.63 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 76872 most?

Urology, with 169,413 services from 4,144 clinicians. Next are Ambulatory Surgical Center, Physician Assistant, Diagnostic Radiology.

CPT 76872

Ultrasound scan of pelvic region through rectum

$93.36Medicare-allowed amount per service, averaged across 208,791 services

Providers submitted

$407.25

Asking price, not received

Medicare allowed

$93.36

The fee schedule figure

Medicare paid

$72.87

Balance is patient coinsurance

Providers submitted an average of $407.25 for this code and Medicare allowed $93.36 — 4.4× 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 $72.87 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $133.54
Hospital / facility: $38.63

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. 120,408 services were billed in an office setting and 88,383 in a facility.

Services: 208,791
Beneficiaries: 200,554
Providers billing it: 4,609
Total allowed: $19,492,728

What Medicare pays for CPT 76872

Across 208,791 services billed by 4,609 providers to 200,554 beneficiaries, Medicare allowed an average of $93.36 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 76872

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	169,413	162,324	$97.88	4,144
Ambulatory Surgical Center	27,505	26,977	$54.13	197
Physician Assistant	1,617	1,608	$93.11	45
Diagnostic Radiology	1,512	1,468	$105.40	60
Internal Medicine	1,429	1,373	$154.73	21
Nurse Practitioner	1,410	1,385	$91.67	28
Radiation Oncology	1,338	1,176	$97.07	26
General Practice	1,111	977	$149.04	8
Independent Diagnostic Testing Facility (IDTF)	659	639	$142.26	17
Family Practice	517	484	$138.22	11
Obstetrics & Gynecology	462	447	$142.96	5
Hematology-Oncology	415	383	$145.17	5
Anesthesiology	285	248	$156.27	3
Colorectal Surgery (Proctology)	257	250	$99.36	14
General Surgery	164	155	$91.42	4

76872 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	22,383	$129.49	$88.23	467
Florida	19,410	$93.31	$72.70	400
New York	19,117	$136.72	$92.27	292
Texas	11,937	$94.94	$75.29	320
New Jersey	11,343	$115.82	$79.29	185
Illinois	8,169	$101.74	$78.05	180
Maryland	8,094	$51.17	$39.51	125
Pennsylvania	7,727	$68.88	$54.42	174
Arizona	7,154	$93.86	$75.99	128
Georgia	6,565	$57.73	$47.62	145
Virginia	6,323	$67.82	$53.65	135
Ohio	6,035	$57.69	$47.44	144
Tennessee	5,726	$66.68	$55.79	104
Massachusetts	5,262	$94.92	$67.31	126
North Carolina	4,285	$100.63	$81.63	137
South Carolina	4,195	$65.67	$53.65	82
Indiana	4,083	$83.42	$70.01	114
Washington	3,933	$94.12	$68.49	87
Colorado	3,879	$97.07	$73.95	95
Michigan	3,839	$107.64	$85.53	112
Missouri	2,732	$91.93	$76.04	77
Nebraska	2,388	$47.83	$39.84	42
Mississippi	2,388	$53.34	$46.70	47
Kansas	2,341	$62.63	$52.55	46
Kentucky	2,296	$77.96	$66.84	37
Minnesota	2,115	$112.69	$87.10	67
Oklahoma	1,945	$64.28	$54.23	56
Arkansas	1,909	$51.73	$44.87	33
Wisconsin	1,833	$82.29	$67.64	70
Louisiana	1,791	$76.71	$65.49	61
Alabama	1,713	$94.38	$82.12	65
Oregon	1,705	$102.18	$77.73	50
Nevada	1,601	$80.89	$67.00	33
South Dakota	1,361	$41.44	$32.68	20
Utah	1,277	$103.91	$89.36	46
Iowa	1,268	$89.72	$74.98	45
Connecticut	1,132	$75.70	$55.16	42
Montana	960	$76.76	$57.79	24
Delaware	951	$83.20	$63.55	21
Idaho	852	$79.60	$66.79	26
New Hampshire	776	$66.43	$50.63	24
District of Columbia	614	$98.48	$66.56	14
Rhode Island	577	$45.20	$35.92	14
West Virginia	516	$42.58	$34.68	26
Alaska	437	$148.41	$107.90	8
New Mexico	399	$107.35	$89.43	17
Vermont	262	$30.83	$23.76	10
Hawaii	247	$93.96	$69.69	7
Maine	222	$71.49	$57.20	10
Wyoming	220	$101.19	$82.92	6
North Dakota	183	$30.85	$23.42	3
Puerto Rico	143	$132.51	$97.60	7
U.S. Virgin Islands	88	$118.86	$96.68	1
Guam	53	$157.65	$108.34	1
XX	37	$147.64	$106.02	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
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.