How much does Medicare pay for CPT 84165?

Medicare allowed an average of $13.51 per service and paid $11.59 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $70.05, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 84165?

Protein measurement, serum. It was billed 1,363,252 times to 952,923 Medicare beneficiaries by 2,182 providers in 2024.

Does 84165 pay differently in an office than a hospital?

Yes. The allowed amount averaged $11.42 in an office setting and $17.27 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 84165 most?

Clinical Laboratory, with 646,641 services from 242 clinicians. Next are Pathology, Hematology-Oncology, Medical Oncology.

CPT 84165

Protein measurement, serum

$13.51Medicare-allowed amount per service, averaged across 1,363,252 services

Providers submitted

$70.05

Asking price, not received

Medicare allowed

$13.51

The fee schedule figure

Medicare paid

$11.59

Balance is patient coinsurance

Providers submitted an average of $70.05 for this code and Medicare allowed $13.51 — 5.2× 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 $11.59 (86%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $11.42
Hospital / facility: $17.27

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 876,019 services were billed in an office setting and 487,233 in a facility.

Services: 1,363,252
Beneficiaries: 952,923
Providers billing it: 2,182
Total allowed: $18,417,535

What Medicare pays for CPT 84165

Across 1,363,252 services billed by 2,182 providers to 952,923 beneficiaries, Medicare allowed an average of $13.51 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 84165

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	646,641	460,265	$10.63	242
Pathology	646,125	451,417	$16.68	1,310
Hematology-Oncology	49,543	27,163	$10.49	329
Medical Oncology	8,795	5,018	$10.52	89
Internal Medicine	3,394	2,393	$14.09	47
Rheumatology	3,019	2,375	$14.35	34
Nurse Practitioner	1,706	1,112	$10.51	51
Hematology	1,133	820	$12.52	8
Physician Assistant	580	428	$10.52	22
Hospitalist	459	321	$10.53	2
General Surgery	434	414	$18.79	1
Family Practice	369	338	$10.51	15
Emergency Medicine	238	161	$10.95	4
Nephrology	224	222	$10.56	10
Endocrinology	176	172	$10.53	8

84165 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
Florida	178,797	$13.48	$11.48	112
California	123,724	$12.99	$11.24	104
New Jersey	120,464	$11.25	$10.74	75
Texas	108,155	$12.12	$11.00	90
North Carolina	80,719	$12.10	$11.09	46
New York	76,567	$14.09	$11.58	189
Ohio	58,519	$13.85	$11.65	109
Massachusetts	57,541	$15.95	$12.13	54
Illinois	47,682	$15.73	$12.35	133
Pennsylvania	42,169	$15.51	$12.17	72
Arizona	40,121	$11.29	$10.75	16
Michigan	31,946	$15.87	$12.24	87
Alabama	30,961	$12.35	$11.32	47
Georgia	30,237	$12.67	$11.39	58
Tennessee	28,976	$12.64	$11.25	99
Wisconsin	25,580	$14.88	$11.99	57
Virginia	25,353	$13.38	$11.57	95
Kansas	24,697	$12.47	$11.20	15
Washington	21,346	$13.49	$11.26	17
Colorado	18,479	$13.82	$11.72	58
Iowa	17,397	$15.68	$12.41	49
Maryland	16,803	$13.71	$11.60	51
Arkansas	14,181	$15.10	$12.40	34
Minnesota	13,527	$14.62	$11.91	117
Oklahoma	11,444	$14.02	$11.83	20
Connecticut	11,175	$17.63	$12.71	34
Missouri	10,227	$16.65	$12.56	44
Indiana	8,764	$15.50	$12.56	43
Kentucky	7,930	$15.45	$12.23	27
Nebraska	7,351	$14.14	$11.73	11
Nevada	7,210	$10.59	$10.56	37
Hawaii	6,816	$14.12	$11.85	7
Utah	6,550	$14.91	$12.42	27
Oregon	6,030	$14.50	$11.77	20
Rhode Island	5,758	$16.25	$12.42	7
North Dakota	5,321	$16.34	$12.38	9
South Carolina	5,231	$16.35	$12.44	15
Maine	5,042	$15.49	$12.48	8
Louisiana	3,790	$14.64	$11.84	12
New Mexico	3,500	$13.20	$11.09	6
Delaware	3,478	$16.96	$12.96	3
Mississippi	3,317	$16.07	$12.56	12
South Dakota	2,760	$14.10	$11.52	11
Idaho	2,498	$15.96	$12.44	15
Montana	1,827	$16.98	$13.06	3
New Hampshire	1,372	$16.82	$12.68	6
District of Columbia	549	$17.45	$12.96	6
West Virginia	362	$16.92	$12.09	2
Vermont	294	$17.08	$12.46	2
Puerto Rico	265	$10.28	$10.53	6
U.S. Virgin Islands	247	$10.49	$10.53	3
ZZ	182	$17.35	$13.56	1
Wyoming	21	$10.53	$10.53	1

Related codes

84153Psa (prostate specific antigen) measurement$17.98
84100Phosphate level$4.63
84156Total protein level$3.59
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.