How much does Medicare pay for CPT 80053?

Medicare allowed an average of $10.33 per service and paid $10.33 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $61.47, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 80053?

Blood test, comprehensive group of blood chemicals. It was billed 27,147,672 times to 15,563,807 Medicare beneficiaries by 26,072 providers in 2024.

Does 80053 pay differently in an office than a hospital?

Yes. The allowed amount averaged $10.33 in an office setting and $10.35 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 80053 most?

Clinical Laboratory, with 20,431,814 services from 1,190 clinicians. Next are Family Practice, Internal Medicine, Hematology-Oncology.

CPT 80053

Blood test, comprehensive group of blood chemicals

$10.33Medicare-allowed amount per service, averaged across 27,147,672 services

Providers submitted

$61.47

Asking price, not received

Medicare allowed

$10.33

The fee schedule figure

Medicare paid

$10.33

Balance is patient coinsurance

Providers submitted an average of $61.47 for this code and Medicare allowed $10.33 — 6.0× 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 $10.33 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $10.33
Hospital / facility: $10.35

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 27,139,259 services were billed in an office setting and 8,413 in a facility.

Services: 27,147,672
Beneficiaries: 15,563,807
Providers billing it: 26,072
Total allowed: $280,435,452

What Medicare pays for CPT 80053

Across 27,147,672 services billed by 26,072 providers to 15,563,807 beneficiaries, Medicare allowed an average of $10.33 per service. That is 1.7 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 80053

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	20,431,814	11,783,284	$10.34	1,190
Family Practice	1,469,539	1,000,456	$10.31	6,566
Internal Medicine	1,381,175	884,276	$10.32	4,451
Hematology-Oncology	1,170,677	401,629	$10.30	1,370
Pathology	815,855	383,526	$10.32	115
Nurse Practitioner	528,057	368,674	$10.30	5,556
Medical Oncology	333,860	112,136	$10.31	445
Rheumatology	219,151	110,775	$10.26	571
Physician Assistant	206,680	148,996	$10.31	2,481
Endocrinology	182,034	107,933	$10.30	526
Cardiology	80,911	57,444	$10.32	436
Nephrology	55,931	32,404	$10.31	269
Gastroenterology	43,220	29,657	$10.24	290
Hematology	40,501	12,680	$10.32	33
General Practice	29,425	18,712	$10.30	106

80053 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
New Jersey	2,973,021	$10.33	$10.34	529
Florida	2,954,930	$10.34	$10.35	1,374
California	2,779,075	$10.34	$10.35	900
Texas	2,716,412	$10.33	$10.35	2,775
North Carolina	2,022,315	$10.33	$10.34	1,414
New York	1,222,495	$10.34	$10.36	1,950
Arizona	1,063,612	$10.34	$10.36	605
Ohio	965,816	$10.32	$10.34	508
Tennessee	913,320	$10.31	$10.35	1,705
Alabama	849,298	$10.32	$10.35	673
Illinois	749,970	$10.33	$10.36	817
Georgia	728,289	$10.33	$10.35	778
Kansas	613,162	$10.34	$10.35	330
Virginia	597,496	$10.32	$10.35	698
Maryland	553,924	$10.34	$10.35	464
Massachusetts	513,017	$10.35	$10.35	666
Pennsylvania	463,307	$10.34	$10.35	209
Washington	462,271	$10.32	$10.35	710
Oklahoma	342,322	$10.33	$10.35	279
Wisconsin	277,310	$10.26	$10.35	383
Colorado	238,757	$10.32	$10.34	212
Nevada	237,818	$10.32	$10.34	97
Oregon	217,377	$10.32	$10.36	495
Arkansas	212,402	$10.31	$10.35	544
South Carolina	205,657	$10.30	$10.35	369
Louisiana	203,376	$10.32	$10.35	428
Missouri	198,450	$10.33	$10.35	512
Michigan	190,439	$10.32	$10.35	340
Mississippi	185,951	$10.27	$10.35	479
Indiana	173,574	$10.32	$10.35	189
Kentucky	149,247	$10.32	$10.35	240
Minnesota	146,498	$10.31	$10.35	1,200
Iowa	137,187	$10.32	$10.35	505
Hawaii	137,054	$10.32	$10.35	8
Nebraska	119,148	$10.33	$10.35	285
Utah	105,828	$10.32	$10.35	445
New Mexico	98,213	$10.31	$10.35	78
Connecticut	52,957	$10.32	$10.34	234
South Dakota	51,156	$10.33	$10.35	210
North Dakota	45,995	$10.33	$10.35	109
Maine	44,606	$10.32	$10.35	222
Puerto Rico	41,329	$10.28	$10.28	318
Idaho	32,662	$10.30	$10.35	107
Rhode Island	27,856	$10.34	$10.35	14
Alaska	26,708	$10.26	$10.32	175
Montana	23,452	$10.33	$10.35	82
West Virginia	23,144	$10.30	$10.35	84
Wyoming	19,799	$10.32	$10.35	113
New Hampshire	11,576	$10.33	$10.35	95
Delaware	8,805	$10.35	$10.35	9
U.S. Virgin Islands	7,025	$10.35	$10.35	6
District of Columbia	6,909	$10.34	$10.35	20
Vermont	3,994	$10.35	$10.37	65
Guam	1,186	$10.18	$10.35	10
XX	75	$9.96	$10.36	1
AE	60	$10.35	$10.35	2

Related codes

80061Blood test, lipids (cholesterol and triglycerides)$13.10
80048Blood test, basic group of blood chemicals (calcium, total)$8.27
80076Liver function blood test panel$7.99
80069Kidney function blood test panel$8.48
80047Blood test, basic group of blood chemicals (calcium, ionized)$13.42
80051Blood test panel for electrolytes (sodium potassium$6.83
80074Acute hepatitis panel$46.60

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.