How much does Medicare pay for CPT 83516?

Medicare allowed an average of $11.28 per service and paid $11.28 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $89.59, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 83516?

Analysis of substance using immunoassay technique, multiple step method. It was billed 407,675 times to 202,199 Medicare beneficiaries by 987 providers in 2024.

Which specialty bills 83516 most?

Clinical Laboratory, with 286,538 services from 201 clinicians. Next are Optometry, Rheumatology, Ophthalmology.

CPT 83516

Analysis of substance using immunoassay technique, multiple step method

$11.28Medicare-allowed amount per service, averaged across 407,675 services

Providers submitted

$89.59

Asking price, not received

Medicare allowed

$11.28

The fee schedule figure

Medicare paid

$11.28

Balance is patient coinsurance

Providers submitted an average of $89.59 for this code and Medicare allowed $11.28 — 7.9× 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 $11.28 (100%); the rest is the patient’s coinsurance and deductible.

Services: 407,675
Beneficiaries: 202,199
Providers billing it: 987
Total allowed: $4,598,574

What Medicare pays for CPT 83516

Across 407,675 services billed by 987 providers to 202,199 beneficiaries, Medicare allowed an average of $11.28 per service. That is 2.0 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 83516

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	286,538	153,326	$11.28	201
Optometry	46,802	17,921	$11.28	391
Rheumatology	34,240	14,387	$11.23	193
Ophthalmology	30,864	12,686	$11.28	136
Physician Assistant	4,007	1,329	$11.28	10
Pathology	2,333	1,083	$11.30	8
Internal Medicine	957	551	$11.17	14
Nurse Practitioner	884	513	$11.24	16
Gastroenterology	382	114	$11.30	5
Endocrinology	166	42	$11.30	2
Dermatology	140	55	$11.30	3
Family Practice	129	51	$11.56	3
Hospitalist	102	50	$11.30	1
Hematology-Oncology	42	42	$11.30	1
Pediatric Medicine	34	17	$11.30	1

83516 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	67,702	$11.29	$11.30	74
Texas	49,759	$11.27	$11.30	57
North Carolina	38,800	$11.30	$11.30	25
New Jersey	34,876	$11.29	$11.30	33
Florida	26,821	$11.28	$11.30	80
Georgia	21,679	$11.29	$11.30	40
New York	19,756	$11.29	$11.30	42
Ohio	16,059	$11.28	$11.30	44
Maryland	13,368	$11.28	$11.30	34
Minnesota	11,961	$11.27	$11.30	36
Pennsylvania	10,098	$11.27	$11.30	59
Arizona	9,544	$11.27	$11.29	12
Alabama	8,505	$11.28	$11.30	17
Tennessee	7,893	$11.26	$11.30	15
Indiana	7,845	$11.25	$11.30	64
Illinois	5,773	$11.30	$11.30	40
Washington	5,668	$11.14	$11.30	32
Kentucky	5,599	$11.24	$11.30	24
Utah	5,137	$11.29	$11.30	10
Virginia	3,889	$11.24	$11.30	25
Wisconsin	3,851	$11.18	$11.30	9
Kansas	3,345	$11.28	$11.30	13
Iowa	2,970	$11.29	$11.30	15
Massachusetts	2,521	$11.27	$11.30	12
Oklahoma	2,420	$11.28	$11.30	11
South Carolina	2,387	$11.27	$11.30	23
Nevada	2,190	$11.18	$11.30	5
Colorado	2,015	$11.29	$11.30	14
Oregon	1,989	$11.26	$11.30	11
Michigan	1,902	$11.25	$11.28	12
Louisiana	1,577	$11.27	$11.30	13
West Virginia	1,325	$11.30	$11.30	6
South Dakota	1,220	$11.28	$11.30	10
New Hampshire	970	$11.23	$11.30	14
New Mexico	934	$11.23	$11.30	3
Nebraska	898	$11.24	$11.30	16
Hawaii	879	$11.30	$11.30	3
Connecticut	815	$11.25	$11.30	8
Rhode Island	573	$11.25	$11.30	1
Missouri	559	$11.29	$11.30	7
Arkansas	365	$11.23	$11.30	4
Mississippi	257	$11.24	$11.30	4
Maine	214	$11.30	$11.30	1
Wyoming	190	$11.15	$11.30	2
Alaska	188	$11.30	$11.30	1
Idaho	181	$11.30	$11.30	2
North Dakota	128	$11.30	$11.30	3
Puerto Rico	80	$11.30	$11.30	1

Related codes

83540Iron level$6.33
83550Iron binding capacity$8.55
83521Measurement of immunoglobulin light chains$16.90
83520Measurement of substance$16.87
83525Insulin measurement$11.18
83519Measurement of substance$18.00
83529Measurement of interleukin-6$16.91
83518Analysis of substance$9.43
83527Insulin measurement$12.66

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.