How much does Medicare pay for CPT 81000?

Medicare allowed an average of $3.92 per service and paid $3.92 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $17.32, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 81000?

Manual urinalysis test with examination using microscope, non-automated. It was billed 579,455 times to 372,027 Medicare beneficiaries by 3,428 providers in 2024.

Which specialty bills 81000 most?

Urology, with 239,973 services from 524 clinicians. Next are Clinical Laboratory, Family Practice, Internal Medicine.

CPT 81000

Manual urinalysis test with examination using microscope, non-automated

$3.92Medicare-allowed amount per service, averaged across 579,455 services

Providers submitted

$17.32

Asking price, not received

Medicare allowed

$3.92

The fee schedule figure

Medicare paid

$3.92

Balance is patient coinsurance

Providers submitted an average of $17.32 for this code and Medicare allowed $3.92 — 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 $3.92 (100%); the rest is the patient’s coinsurance and deductible.

Services: 579,455
Beneficiaries: 372,027
Providers billing it: 3,428
Total allowed: $2,271,464

What Medicare pays for CPT 81000

Across 579,455 services billed by 3,428 providers to 372,027 beneficiaries, Medicare allowed an average of $3.92 per service. That is 1.6 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 81000

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	239,973	138,258	$3.92	524
Clinical Laboratory	109,745	65,713	$3.95	268
Family Practice	80,306	57,034	$3.91	883
Internal Medicine	51,308	37,162	$3.88	437
Nurse Practitioner	27,975	21,507	$3.91	343
Physician Assistant	25,867	21,472	$3.91	435
Nephrology	13,071	9,800	$3.91	183
Obstetrics & Gynecology	9,338	6,744	$3.93	95
Rheumatology	3,818	2,210	$3.87	37
General Practice	2,944	1,835	$3.92	39
Endocrinology	2,770	1,750	$3.92	16
Cardiology	2,681	1,942	$3.93	11
Hematology-Oncology	2,493	1,319	$3.92	65
Emergency Medicine	1,944	1,625	$3.92	31
Pathology	1,578	1,245	$3.94	8

81000 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	101,349	$3.94	$3.94	319
Florida	56,282	$3.97	$3.94	112
Texas	47,345	$3.87	$3.94	259
Virginia	42,575	$3.92	$3.94	332
New York	36,760	$3.93	$3.94	134
North Carolina	18,553	$3.92	$3.94	129
Maryland	17,609	$3.92	$3.94	247
Georgia	16,265	$3.91	$3.94	74
Puerto Rico	16,093	$3.90	$3.94	196
New Jersey	14,855	$3.94	$3.94	77
South Carolina	14,839	$3.92	$3.94	72
Michigan	14,624	$3.90	$3.94	133
Louisiana	14,409	$3.90	$3.94	68
Pennsylvania	13,695	$3.93	$3.94	179
Mississippi	13,673	$3.90	$3.94	94
Alabama	13,307	$3.88	$3.94	95
Arkansas	12,411	$3.92	$3.94	80
Arizona	11,586	$3.93	$3.94	29
Missouri	9,636	$3.93	$3.94	23
Massachusetts	8,916	$3.93	$3.94	42
Washington	7,629	$3.88	$3.94	35
Tennessee	6,857	$3.89	$3.94	69
Illinois	6,640	$3.93	$3.94	80
Ohio	6,197	$3.92	$3.94	66
Oregon	5,960	$3.92	$3.94	44
Indiana	5,301	$3.94	$3.94	37
Oklahoma	5,016	$3.93	$3.94	28
Kentucky	4,562	$3.92	$3.94	42
Nebraska	4,364	$3.92	$3.94	36
Utah	3,968	$3.92	$3.94	24
Iowa	3,767	$3.93	$3.94	21
Wyoming	3,764	$3.92	$3.94	6
Colorado	3,633	$3.92	$3.94	48
Kansas	2,968	$3.93	$3.94	19
Hawaii	2,571	$3.83	$3.94	11
Connecticut	1,872	$3.93	$3.94	22
Nevada	1,273	$3.90	$3.94	17
New Mexico	1,036	$3.92	$3.94	16
U.S. Virgin Islands	973	$3.94	$3.94	3
West Virginia	878	$3.93	$3.94	9
Maine	832	$3.94	$3.94	19
Wisconsin	825	$3.94	$3.94	13
Alaska	819	$3.92	$3.94	14
North Dakota	762	$3.93	$3.94	13
Idaho	630	$3.92	$3.94	13
Montana	527	$3.94	$3.94	8
South Dakota	339	$3.94	$3.94	2
New Hampshire	303	$3.93	$3.94	6
Delaware	202	$3.92	$3.94	6
District of Columbia	165	$3.94	$3.94	5
Minnesota	40	$3.87	$3.94	2

Related codes

81001Manual urinalysis test$3.10
81003Automated urinalysis test$2.19
81002Urinalysis, manual test$3.39
81007Urinalysis for bacteria$29.27
81015Urinalysis using microscope$2.98
81050Urine volume measurement$3.57
81005Analysis of urine$2.13
81025Urine pregnancy test$8.33

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.