How much does Medicare pay for CPT 84295?

Medicare allowed an average of $4.58 per service and paid $4.58 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $17.32, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 84295?

Blood sodium level. It was billed 249,697 times to 165,228 Medicare beneficiaries by 657 providers in 2024.

Does 84295 pay differently in an office than a hospital?

Yes. The allowed amount averaged $4.58 in an office setting and $4.62 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 84295 most?

Clinical Laboratory, with 162,099 services from 208 clinicians. Next are Hematology-Oncology, Family Practice, Internal Medicine.

CPT 84295

Blood sodium level

$4.58Medicare-allowed amount per service, averaged across 249,697 services

Providers submitted

$17.32

Asking price, not received

Medicare allowed

$4.58

The fee schedule figure

Medicare paid

$4.58

Balance is patient coinsurance

Providers submitted an average of $17.32 for this code and Medicare allowed $4.58 — 3.8× 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 $4.58 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $4.58
Hospital / facility: $4.62

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 249,683 services were billed in an office setting and 14 in a facility.

Services: 249,697
Beneficiaries: 165,228
Providers billing it: 657
Total allowed: $1,143,612

What Medicare pays for CPT 84295

Across 249,697 services billed by 657 providers to 165,228 beneficiaries, Medicare allowed an average of $4.58 per service. That is 1.5 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 84295

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	162,099	122,128	$4.52	208
Hematology-Oncology	27,767	7,811	$4.69	19
Family Practice	21,726	12,230	$4.70	109
Internal Medicine	17,510	9,660	$4.70	137
Rheumatology	5,008	2,882	$4.68	18
Nurse Practitioner	3,411	2,338	$4.70	66
Pathology	2,210	1,713	$4.71	14
Physician Assistant	2,160	1,576	$4.68	39
Cardiology	1,583	1,019	$4.71	8
Pulmonary Disease	1,500	1,023	$4.70	11
Urology	1,219	787	$4.66	5
Interventional Cardiology	1,124	530	$4.69	2
Endocrinology	958	616	$4.66	5
Neurology	631	358	$4.71	1
General Surgery	292	211	$4.66	7

84295 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	38,531	$4.67	$4.68	69
Florida	32,384	$4.66	$4.69	42
North Carolina	20,651	$4.43	$4.44	35
New Jersey	19,775	$4.40	$4.40	10
Indiana	18,334	$4.68	$4.71	15
South Carolina	16,236	$4.70	$4.71	48
Texas	14,972	$4.48	$4.49	17
Illinois	12,748	$4.68	$4.68	11
Minnesota	11,032	$4.70	$4.71	41
Ohio	10,908	$4.27	$4.27	9
Arizona	8,766	$4.55	$4.55	6
Alabama	6,155	$4.48	$4.48	3
Massachusetts	5,428	$4.71	$4.71	142
Wisconsin	4,235	$4.68	$4.71	47
Pennsylvania	3,364	$4.68	$4.71	14
Iowa	3,243	$4.69	$4.71	30
Washington	3,195	$4.38	$4.43	6
Colorado	3,039	$4.46	$4.48	9
New York	2,888	$4.58	$4.59	10
Kansas	2,751	$4.56	$4.56	9
Hawaii	2,462	$4.63	$4.71	5
Virginia	1,729	$4.70	$4.71	10
Georgia	1,126	$4.71	$4.71	6
Tennessee	862	$4.47	$4.47	9
Louisiana	753	$4.67	$4.67	4
Oklahoma	699	$3.18	$3.18	4
Mississippi	602	$4.70	$4.71	4
Nevada	559	$4.70	$4.71	4
Michigan	383	$4.36	$4.36	4
Maryland	356	$4.71	$4.71	4
Arkansas	325	$4.71	$4.71	2
Oregon	262	$4.56	$4.56	4
South Dakota	160	$4.69	$4.71	2
Kentucky	153	$4.71	$4.71	4
Rhode Island	122	$4.71	$4.71	1
Missouri	101	$4.71	$4.71	4
New Mexico	80	$4.71	$4.71	2
Connecticut	68	$4.71	$4.71	3
North Dakota	62	$4.71	$4.71	1
Utah	56	$4.71	$4.71	2
District of Columbia	49	$4.11	$4.11	2
New Hampshire	33	$4.66	$4.66	1
Maine	32	$3.47	$3.47	1
Nebraska	28	$4.71	$4.71	1

Related codes

84270Sex hormone binding globulin (protein) level$21.18
84207Vitamin b-6 level$27.10
84244Renin (kidney enzyme) level$21.41
84238Chemical receptor analysis$35.31
84252Vitamin b-2 (riboflavin) level$19.81
84255Selenium (vitamin) level$24.95
84260Serotonin (hormone) level$30.23
84206Proinsulin (pancreatic hormone) level$26.15

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.