How much does Medicare pay for CPT 84681?

Medicare allowed an average of $20.35 per service and paid $20.35 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $88.43, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 84681?

C-peptide (protein) level. It was billed 163,404 times to 126,630 Medicare beneficiaries by 414 providers in 2024.

Which specialty bills 84681 most?

Clinical Laboratory, with 126,280 services from 198 clinicians. Next are Endocrinology, Internal Medicine, Family Practice.

CPT 84681

C-peptide (protein) level

$20.35Medicare-allowed amount per service, averaged across 163,404 services

Providers submitted

$88.43

Asking price, not received

Medicare allowed

$20.35

The fee schedule figure

Medicare paid

$20.35

Balance is patient coinsurance

Providers submitted an average of $88.43 for this code and Medicare allowed $20.35 — 4.3× 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 $20.35 (100%); the rest is the patient’s coinsurance and deductible.

Services: 163,404
Beneficiaries: 126,630
Providers billing it: 414
Total allowed: $3,325,271

What Medicare pays for CPT 84681

Across 163,404 services billed by 414 providers to 126,630 beneficiaries, Medicare allowed an average of $20.35 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 84681

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	126,280	104,779	$20.37	198
Endocrinology	19,268	10,827	$20.28	79
Internal Medicine	8,903	5,082	$20.33	46
Family Practice	4,189	2,662	$20.33	29
Nurse Practitioner	2,339	1,510	$20.34	34
Pathology	644	584	$20.08	6
Nephrology	562	291	$20.32	2
Emergency Medicine	350	211	$20.33	2
Physician Assistant	326	240	$20.25	9
Urology	208	190	$20.39	1
General Practice	136	116	$20.32	5
Cardiology	133	82	$20.39	1
Obstetrics & Gynecology	38	32	$18.57	1
Hematology-Oncology	28	24	$20.39	1

84681 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	26,527	$20.37	$20.39	64
New Jersey	20,922	$20.37	$20.39	32
California	17,996	$20.37	$20.39	51
New York	13,403	$20.33	$20.39	40
Texas	13,346	$20.31	$20.39	33
Ohio	11,720	$20.38	$20.39	11
North Carolina	8,649	$20.35	$20.39	11
Massachusetts	8,015	$20.38	$20.39	4
Arizona	6,648	$20.35	$20.39	10
Georgia	5,983	$20.35	$20.39	7
Alabama	4,295	$20.33	$20.39	9
Tennessee	3,763	$20.27	$20.39	26
Kansas	3,208	$20.39	$20.39	4
Illinois	2,842	$20.39	$20.39	7
Maryland	2,569	$20.39	$20.39	6
Washington	1,995	$20.39	$20.39	4
Pennsylvania	1,568	$20.39	$20.39	5
Virginia	1,512	$20.34	$20.39	10
Oklahoma	1,352	$20.31	$20.39	4
Nevada	1,203	$20.37	$20.39	3
Colorado	732	$20.34	$20.39	3
Kentucky	665	$20.30	$20.39	4
Wisconsin	581	$19.60	$20.39	5
South Carolina	515	$20.27	$20.39	6
Mississippi	478	$19.89	$20.39	6
Minnesota	474	$20.28	$20.39	3
Indiana	381	$20.29	$20.39	6
Oregon	327	$20.15	$20.39	3
Hawaii	255	$20.23	$20.39	2
Utah	255	$19.99	$20.39	6
Louisiana	221	$20.39	$20.39	5
Michigan	198	$20.39	$20.39	4
Missouri	151	$20.28	$20.39	2
New Mexico	102	$20.24	$20.39	1
Idaho	84	$20.39	$20.39	4
North Dakota	80	$20.39	$20.39	1
Iowa	71	$20.39	$20.39	1
Rhode Island	67	$20.39	$20.39	1
South Dakota	57	$20.15	$20.39	2
Arkansas	49	$20.39	$20.39	1
Puerto Rico	35	$19.40	$20.39	1
Maine	35	$20.39	$20.39	1
Connecticut	22	$20.39	$20.39	2
Alaska	22	$20.22	$20.39	1
New Hampshire	17	$20.39	$20.39	1
Nebraska	14	$18.93	$20.39	1

Related codes

84630Zinc level$11.10

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.