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CPT 81001

Manual urinalysis test with examination using microscope, automated

$3.10Medicare-allowed amount per service, averaged across 6,288,838 services
Providers submitted
$32.06

Asking price, not received

Medicare allowed
$3.10

The fee schedule figure

Medicare paid
$3.10

Balance is patient coinsurance

Providers submitted an average of $32.06 for this code and Medicare allowed $3.10 — 10.3× 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 $3.10 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility
$3.10
Hospital / facility
$3.11

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 6,286,134 services were billed in an office setting and 2,704 in a facility.

Services
6,288,838

Medicare Part B, 2024

Beneficiaries
4,383,790
Providers billing it
12,761
Total allowed
$19,495,398

Services × allowed amount

What Medicare pays for CPT 81001

Across 6,288,838 services billed by 12,761 providers to 4,383,790 beneficiaries, Medicare allowed an average of $3.10 per service. That is 1.4 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 81001

SpecialtyServicesBeneficiariesAvg allowedProviders
Clinical Laboratory4,923,9063,389,345$3.11787
Urology374,866242,429$3.091,054
Internal Medicine268,311204,897$3.102,396
Family Practice261,314198,267$3.093,476
Nurse Practitioner158,937122,322$3.092,325
Pathology101,56376,839$3.1080
Physician Assistant88,66869,065$3.091,316
Nephrology45,56331,660$3.09406
Rheumatology11,7948,551$3.07218
Hematology-Oncology9,5226,260$3.09111
Emergency Medicine8,6467,672$3.10173
Obstetrics & Gynecology7,1415,227$3.09123
Endocrinology5,8404,184$3.0849
General Practice5,4374,175$3.0943
Cardiology3,4552,896$3.0918

81001 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.

StateServicesAllowedStandardized pmtProviders
New Jersey865,254$3.11$3.11236
California828,216$3.11$3.11393
Florida728,377$3.11$3.11592
Texas607,377$3.10$3.111,001
North Carolina425,237$3.11$3.11983
New York254,839$3.11$3.11499
Arizona211,820$3.11$3.11166
Ohio173,749$3.11$3.11175
Illinois172,136$3.11$3.11160
Tennessee153,972$3.09$3.11693
Georgia137,086$3.10$3.11294
Alabama126,134$3.10$3.11308
Massachusetts123,799$3.11$3.11155
Maryland111,398$3.11$3.11191
Kansas107,182$3.11$3.11264
Virginia103,263$3.10$3.11362
South Carolina97,559$3.10$3.11511
Oklahoma84,203$3.10$3.11124
Pennsylvania81,719$3.10$3.11104
Wisconsin74,473$3.08$3.11725
Washington73,996$3.10$3.11318
Nevada70,595$3.10$3.1111
Minnesota58,395$3.10$3.11953
Louisiana57,838$3.10$3.11235
Mississippi51,325$3.09$3.11324
Hawaii49,337$3.10$3.117
Missouri48,323$3.11$3.11220
Indiana41,928$3.10$3.11168
Nebraska39,005$3.10$3.11321
Oregon38,078$3.10$3.11156
Kentucky35,089$3.10$3.11195
Iowa34,128$3.10$3.11395
Colorado33,470$3.10$3.1192
Arkansas33,317$3.09$3.11286
Michigan24,507$3.11$3.11115
Puerto Rico20,985$3.09$3.11119
South Dakota19,191$3.10$3.11167
New Mexico15,824$3.10$3.1129
Idaho13,454$3.09$3.1166
Utah13,304$3.09$3.11151
Connecticut9,366$3.10$3.1177
North Dakota7,316$3.10$3.1191
Montana4,967$3.10$3.1155
Alaska4,888$3.09$3.1169
U.S. Virgin Islands4,555$3.11$3.113
Wyoming3,839$3.10$3.1154
Maine3,516$3.10$3.1145
West Virginia2,952$3.08$3.1137
Rhode Island2,302$3.10$3.113
District of Columbia2,101$3.10$3.1112
New Hampshire1,892$3.10$3.1132
Delaware904$3.09$3.116
Guam282$3.08$3.119
Vermont37$3.11$3.112
AP23$3.11$3.111
AE16$3.11$3.111

Related codes

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.