How much does Medicare pay for CPT 84153?

Medicare allowed an average of $17.98 per service and paid $17.98 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $103.29, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 84153?

Psa (prostate specific antigen) measurement, total. It was billed 3,225,143 times to 2,410,613 Medicare beneficiaries by 8,103 providers in 2024.

Does 84153 pay differently in an office than a hospital?

Yes. The allowed amount averaged $17.98 in an office setting and $18.02 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 84153 most?

Clinical Laboratory, with 2,319,088 services from 671 clinicians. Next are Urology, Pathology, Internal Medicine.

CPT 84153

Psa (prostate specific antigen) measurement, total

$17.98Medicare-allowed amount per service, averaged across 3,225,143 services

Providers submitted

$103.29

Asking price, not received

Medicare allowed

$17.98

The fee schedule figure

Medicare paid

$17.98

Balance is patient coinsurance

Providers submitted an average of $103.29 for this code and Medicare allowed $17.98 — 5.7× 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 $17.98 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $17.98
Hospital / facility: $18.02

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 3,225,079 services were billed in an office setting and 64 in a facility.

Services: 3,225,143
Beneficiaries: 2,410,613
Providers billing it: 8,103
Total allowed: $57,988,071

What Medicare pays for CPT 84153

Across 3,225,143 services billed by 8,103 providers to 2,410,613 beneficiaries, Medicare allowed an average of $17.98 per service. That is 1.3 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 84153

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	2,319,088	1,748,400	$18.00	671
Urology	358,572	265,503	$17.93	1,410
Pathology	173,769	121,290	$17.96	67
Internal Medicine	114,518	94,811	$17.96	1,961
Family Practice	87,401	74,485	$17.92	1,898
Hematology-Oncology	58,282	24,173	$17.95	608
Nurse Practitioner	42,531	34,168	$17.92	607
Physician Assistant	28,473	23,003	$17.89	379
Medical Oncology	17,341	6,881	$17.96	172
Cardiology	5,517	3,746	$17.94	33
Radiation Oncology	4,627	3,193	$17.98	77
Endocrinology	3,943	2,764	$17.98	64
General Practice	2,204	1,874	$17.85	30
Pediatric Medicine	1,912	1,530	$17.89	12
Hematology	1,879	771	$17.97	14

84153 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	422,473	$18.00	$18.02	315
New Jersey	407,236	$18.00	$18.02	228
Florida	342,428	$18.01	$18.02	516
Texas	282,154	$17.98	$18.02	806
North Carolina	194,990	$18.00	$18.02	376
New York	168,244	$17.99	$18.02	658
Arizona	134,902	$18.00	$18.02	126
Tennessee	104,624	$17.93	$18.02	490
Illinois	86,744	$17.99	$18.02	298
Ohio	86,459	$17.99	$18.02	196
Alabama	76,934	$17.92	$18.02	234
Massachusetts	75,582	$18.00	$18.02	202
Maryland	70,706	$17.99	$18.02	174
Virginia	70,213	$17.94	$18.02	354
Georgia	69,211	$17.98	$18.02	284
Kansas	66,980	$18.01	$18.02	137
Washington	53,441	$17.98	$18.02	138
Pennsylvania	52,013	$18.01	$18.02	99
Oklahoma	34,307	$17.99	$18.02	91
Mississippi	30,127	$17.85	$18.02	124
Colorado	29,898	$17.99	$18.02	68
Indiana	28,305	$17.97	$18.02	99
Michigan	27,930	$17.99	$18.02	118
Wisconsin	27,911	$17.82	$18.02	77
Minnesota	27,050	$17.95	$18.02	155
South Carolina	25,606	$17.95	$18.02	184
Oregon	22,690	$17.96	$18.02	100
Nevada	21,508	$17.97	$18.02	46
Louisiana	20,798	$17.93	$18.02	107
Arkansas	20,710	$17.90	$18.02	161
Hawaii	17,863	$17.92	$18.02	5
Nebraska	17,568	$17.96	$18.02	148
Missouri	17,229	$17.96	$18.02	151
Iowa	17,049	$17.98	$18.02	172
Utah	12,290	$17.97	$18.02	135
Kentucky	11,705	$17.86	$18.02	75
South Dakota	8,317	$17.97	$18.02	69
New Mexico	8,138	$17.94	$18.02	20
Puerto Rico	5,566	$17.92	$18.02	98
Rhode Island	3,629	$18.01	$18.02	1
Idaho	3,188	$17.95	$18.02	32
Connecticut	3,122	$17.94	$18.02	56
Maine	3,002	$18.01	$18.02	24
Montana	2,732	$17.97	$18.02	29
North Dakota	2,699	$17.99	$18.02	11
Wyoming	2,502	$17.96	$18.02	33
West Virginia	1,628	$17.82	$18.02	19
Alaska	1,359	$17.85	$18.02	27
U.S. Virgin Islands	1,291	$17.92	$17.99	4
New Hampshire	1,087	$18.00	$18.02	14
District of Columbia	693	$17.99	$18.02	12
Delaware	231	$18.02	$18.02	3
Vermont	59	$17.76	$18.02	3
Guam	22	$15.89	$18.02	1

Related codes

84100Phosphate level$4.63
84156Total protein level$3.59
84165Protein measurement$13.51
84155Total protein level$3.55
84154Psa (prostate specific antigen) measurement$18.00
84132Blood potassium level$4.63
84166Protein measurement$17.39
84144Progesterone (reproductive hormone) level$20.40
84146Prolactin (milk producing hormone) level$18.95
84134Prealbumin (protein) level$14.28
84133Urine potassium level$4.64
84105Urine phosphate level$5.66

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.