How much does Medicare pay for CPT 88120?

Medicare allowed an average of $465.04 per service and paid $368.66 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1357.86, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 88120?

Cell examination of urine, manual. It was billed 53,969 times to 42,189 Medicare beneficiaries by 242 providers in 2024.

Does 88120 pay differently in an office than a hospital?

Yes. The allowed amount averaged $474.24 in an office setting and $57.10 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 88120 most?

Pathology, with 29,000 services from 134 clinicians. Next are Clinical Laboratory, Urology, Nurse Practitioner.

CPT 88120

Cell examination of urine, manual

$465.04Medicare-allowed amount per service, averaged across 53,969 services

Providers submitted

$1357.86

Asking price, not received

Medicare allowed

$465.04

The fee schedule figure

Medicare paid

$368.66

Balance is patient coinsurance

Providers submitted an average of $1357.86 for this code and Medicare allowed $465.04 — 2.9× 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 $368.66 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $474.24
Hospital / facility: $57.10

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 52,778 services were billed in an office setting and 1,191 in a facility.

Services: 53,969
Beneficiaries: 42,189
Providers billing it: 242
Total allowed: $25,097,744

What Medicare pays for CPT 88120

Across 53,969 services billed by 242 providers to 42,189 beneficiaries, Medicare allowed an average of $465.04 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 88120

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pathology	29,000	23,970	$457.51	134
Clinical Laboratory	18,790	14,432	$516.82	56
Urology	6,111	3,756	$344.08	51
Nurse Practitioner	68	31	$237.35	1

88120 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
New Jersey	9,037	$553.28	$377.95	22
New York	6,234	$415.92	$276.61	33
California	5,367	$518.25	$346.90	17
Pennsylvania	4,913	$478.60	$306.40	13
Massachusetts	4,456	$420.21	$292.49	30
Texas	3,591	$453.58	$360.46	19
Florida	3,183	$411.98	$324.38	18
Maryland	2,446	$624.17	$422.91	10
Illinois	2,132	$467.39	$371.17	5
Connecticut	2,122	$473.64	$343.58	5
Tennessee	2,031	$512.97	$443.47	7
Oklahoma	1,977	$393.86	$344.17	1
Arizona	1,913	$338.48	$282.52	13
Missouri	1,672	$293.35	$253.18	7
Virginia	774	$477.80	$382.37	5
Ohio	496	$108.63	$92.04	9
Washington	458	$559.11	$451.18	2
Minnesota	217	$293.00	$226.52	6
District of Columbia	202	$565.55	$421.81	1
Colorado	194	$475.47	$321.41	2
Delaware	154	$131.79	$108.20	3
Louisiana	78	$117.66	$93.92	3
Georgia	64	$533.35	$455.61	2
North Carolina	57	$53.51	$42.95	1
Wisconsin	54	$54.85	$42.86	1
Michigan	41	$522.84	$453.83	2
Nevada	39	$565.30	$450.61	1
South Carolina	29	$53.27	$42.11	1
Iowa	24	$54.16	$43.49	2
Utah	14	$493.65	$452.78	1

Related codes

88185Flow cytometry technique for dna or cell analysis$24.39
88112Cell examination of specimen$38.46
88173Evaluation of fine needle aspirate$83.18
88189Flow cytometry technique for dna or cell analysis$82.33
88108Cell examination of specimen$28.49
88175Pap test, automated thin layer preparation; automated system and manua$25.99
88172Evaluation of fine needle aspirate$36.27
88184Flow cytometry technique for dna or cell analysis$81.32
88188Flow cytometry technique for dna or cell analysis$60.36
88177Pap test, evaluation of fine needle aspirate, immediate, each addition$21.33
88141Pap test$24.26
88121Cell examination of urine$380.49

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.