How much does Medicare pay for CPT 84520?

Medicare allowed an average of $3.85 per service and paid $3.85 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $16.75, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 84520?

Urea nitrogen level to assess kidney function, quantitative. It was billed 439,486 times to 317,599 Medicare beneficiaries by 1,350 providers in 2024.

Does 84520 pay differently in an office than a hospital?

Yes. The allowed amount averaged $3.85 in an office setting and $3.87 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 84520 most?

Clinical Laboratory, with 312,490 services from 339 clinicians. Next are Family Practice, Internal Medicine, Hematology-Oncology.

CPT 84520

Urea nitrogen level to assess kidney function, quantitative

$3.85Medicare-allowed amount per service, averaged across 439,486 services

Providers submitted

$16.75

Asking price, not received

Medicare allowed

$3.85

The fee schedule figure

Medicare paid

$3.85

Balance is patient coinsurance

Providers submitted an average of $16.75 for this code and Medicare allowed $3.85 — 4.4× 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 $3.85 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $3.85
Hospital / facility: $3.87

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 439,468 services were billed in an office setting and 18 in a facility.

Services: 439,486
Beneficiaries: 317,599
Providers billing it: 1,350
Total allowed: $1,692,021

What Medicare pays for CPT 84520

Across 439,486 services billed by 1,350 providers to 317,599 beneficiaries, Medicare allowed an average of $3.85 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 84520

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	312,490	242,589	$3.84	339
Family Practice	25,429	14,516	$3.86	135
Internal Medicine	22,134	12,508	$3.87	131
Hematology-Oncology	19,678	7,171	$3.86	66
Rheumatology	17,312	9,956	$3.86	51
Pathology	7,443	5,733	$3.85	40
Urology	6,752	5,855	$3.86	130
Nurse Practitioner	4,788	3,654	$3.86	119
Endocrinology	4,519	2,234	$3.86	11
Physician Assistant	4,132	3,353	$3.85	93
Nephrology	3,444	1,808	$3.87	12
Cardiology	2,533	1,835	$3.87	40
Interventional Cardiology	1,316	708	$3.86	9
Neurology	1,047	761	$3.86	16
Ophthalmology	832	229	$3.86	2

84520 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	59,972	$3.85	$3.86	110
Texas	56,503	$3.86	$3.87	103
Florida	47,213	$3.86	$3.88	81
New Jersey	46,608	$3.85	$3.85	33
North Carolina	38,634	$3.85	$3.86	54
Massachusetts	21,684	$3.87	$3.87	105
New York	18,139	$3.85	$3.86	105
South Carolina	16,380	$3.87	$3.87	52
Ohio	14,280	$3.85	$3.86	43
Illinois	13,537	$3.80	$3.82	99
Arizona	10,165	$3.66	$3.67	7
Alabama	10,029	$3.86	$3.86	12
Michigan	9,121	$3.86	$3.87	33
Maryland	7,909	$3.85	$3.87	17
Pennsylvania	7,328	$3.86	$3.87	31
Indiana	6,933	$3.85	$3.87	14
Iowa	4,864	$3.85	$3.87	44
Minnesota	4,847	$3.86	$3.87	16
Colorado	3,748	$3.86	$3.86	8
Kansas	3,732	$3.86	$3.86	12
Virginia	3,472	$3.87	$3.87	20
Wisconsin	3,169	$3.83	$3.87	31
Mississippi	3,137	$3.86	$3.87	19
Nevada	3,089	$3.87	$3.87	6
Tennessee	2,767	$3.82	$3.83	15
Washington	2,758	$3.75	$3.76	7
Hawaii	2,555	$3.82	$3.87	6
Rhode Island	2,130	$3.86	$3.87	3
Missouri	2,068	$3.85	$3.87	81
Louisiana	2,068	$3.85	$3.86	14
Georgia	1,990	$3.87	$3.87	19
Oklahoma	1,982	$3.30	$3.30	27
South Dakota	1,443	$3.87	$3.87	17
Kentucky	842	$3.86	$3.87	22
Nebraska	711	$3.86	$3.87	24
Connecticut	606	$3.82	$3.84	5
Puerto Rico	589	$3.85	$3.85	8
New Hampshire	543	$3.85	$3.86	6
Oregon	350	$3.86	$3.87	5
New Mexico	335	$3.81	$3.81	2
Arkansas	310	$3.87	$3.87	7
Maine	232	$3.67	$3.71	2
Utah	221	$3.87	$3.87	5
Idaho	149	$3.87	$3.87	2
West Virginia	102	$3.83	$3.87	6
Wyoming	89	$3.87	$3.87	4
Delaware	53	$3.87	$3.87	3
Montana	33	$3.87	$3.87	2
District of Columbia	31	$3.87	$3.87	1
Vermont	22	$3.87	$3.87	1
North Dakota	14	$3.87	$3.87	1

Related codes

84550Uric acid level$4.42
84560Uric acid level$4.98
84540Urea nitrogen level to assess kidney function$5.44
84590Vitamin a level$11.34
84580Urobilinogen (metabolism substance) level$9.33
84597Vitamin k level$13.43
84585Urine vanillylmandelic acid$15.19
84591Vitamin measurement$16.71
84586Vasoactive intestinal peptide (intestinal hormone) level$34.58
84588Adh (antidiuretic hormone) level$33.24

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.