How much does Medicare pay for CPT 83605?

Medicare allowed an average of $11.31 per service and paid $11.31 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $65.56, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 83605?

Lactic acid level. It was billed 19,715 times to 16,593 Medicare beneficiaries by 172 providers in 2024.

Does 83605 pay differently in an office than a hospital?

Yes. The allowed amount averaged $11.31 in an office setting and $11.34 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 83605 most?

Clinical Laboratory, with 16,668 services from 117 clinicians. Next are Endocrinology, Internal Medicine, Pathology.

CPT 83605

Lactic acid level

$11.31Medicare-allowed amount per service, averaged across 19,715 services

Providers submitted

$65.56

Asking price, not received

Medicare allowed

$11.31

The fee schedule figure

Medicare paid

$11.31

Balance is patient coinsurance

Providers submitted an average of $65.56 for this code and Medicare allowed $11.31 — 5.8× 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 $11.31 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $11.31
Hospital / facility: $11.34

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 19,701 services were billed in an office setting and 14 in a facility.

Services: 19,715
Beneficiaries: 16,593
Providers billing it: 172
Total allowed: $222,977

What Medicare pays for CPT 83605

Across 19,715 services billed by 172 providers to 16,593 beneficiaries, Medicare allowed an average of $11.31 per service. That is 1.2 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 83605

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	16,668	14,524	$11.32	117
Endocrinology	956	374	$11.33	2
Internal Medicine	542	317	$11.30	5
Pathology	506	428	$11.05	6
Pulmonary Disease	441	370	$11.31	8
Physician Assistant	252	242	$11.34	11
Nurse Practitioner	172	166	$11.34	10
Emergency Medicine	137	133	$11.34	10
Family Practice	26	25	$11.34	2
Hematology-Oncology	15	14	$11.34	1

83605 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
North Carolina	5,823	$11.34	$11.34	3
California	3,465	$11.32	$11.34	26
New York	1,533	$11.32	$11.34	8
New Jersey	1,153	$11.34	$11.34	9
Florida	1,039	$11.32	$11.34	13
Texas	1,033	$11.32	$11.34	13
Maryland	746	$11.24	$11.34	6
Pennsylvania	470	$11.32	$11.34	5
Ohio	400	$11.31	$11.34	7
Arizona	398	$11.31	$11.34	9
Georgia	369	$11.31	$11.34	4
Nevada	322	$11.28	$11.34	4
Wisconsin	314	$11.27	$11.34	3
Minnesota	303	$11.21	$11.34	7
Virginia	297	$11.31	$11.34	7
Kansas	285	$11.34	$11.34	3
Washington	244	$10.92	$11.34	7
Hawaii	209	$11.31	$11.34	2
Illinois	199	$11.34	$11.34	5
Tennessee	190	$11.34	$11.34	3
Oklahoma	170	$11.29	$11.34	4
Massachusetts	159	$11.27	$11.34	2
Alabama	118	$11.34	$11.34	1
Colorado	115	$11.13	$11.34	6
Oregon	86	$11.25	$11.34	4
South Dakota	53	$11.34	$11.34	1
New Mexico	40	$11.34	$11.34	2
Utah	39	$11.34	$11.34	1
Wyoming	38	$11.34	$11.34	2
Iowa	31	$11.34	$11.34	1
Indiana	25	$11.34	$11.34	1
Missouri	24	$11.34	$11.34	1
Kentucky	14	$11.34	$11.34	1
Rhode Island	11	$11.34	$11.34	1

Related codes

83615Lactate dehydrogenase (enzyme) level$5.89
83690Lipase (fat enzyme) level$6.74
83695Lipoprotein (a) level$13.99
83698Lipoprotein-associated phospholipase a2 (enzyme) level$45.28
83625Lactate dehydrogenase (enzyme) measurement$12.53
83655Lead level$11.84
83631Stool lactoferrin (immune system protein) level$19.22
83630Stool lactoferrin (immune system protein) analysis$19.26

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.