How much does Medicare pay for CPT 88172?

Medicare allowed an average of $36.27 per service and paid $28.61 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $158.47, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 88172?

Evaluation of fine needle aspirate. It was billed 101,175 times to 70,056 Medicare beneficiaries by 2,071 providers in 2024.

Does 88172 pay differently in an office than a hospital?

Yes. The allowed amount averaged $49.60 in an office setting and $33.96 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 88172 most?

Pathology, with 94,422 services from 1,998 clinicians. Next are Clinical Laboratory, Endocrinology, Diagnostic Radiology.

CPT 88172

Evaluation of fine needle aspirate

$36.27Medicare-allowed amount per service, averaged across 101,175 services

Providers submitted

$158.47

Asking price, not received

Medicare allowed

$36.27

The fee schedule figure

Medicare paid

$28.61

Balance is patient coinsurance

Providers submitted an average of $158.47 for this code and Medicare allowed $36.27 — 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 $28.61 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $49.60
Hospital / facility: $33.96

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. 14,911 services were billed in an office setting and 86,264 in a facility.

Services: 101,175
Beneficiaries: 70,056
Providers billing it: 2,071
Total allowed: $3,669,617

What Medicare pays for CPT 88172

Across 101,175 services billed by 2,071 providers to 70,056 beneficiaries, Medicare allowed an average of $36.27 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 88172

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pathology	94,422	65,731	$35.79	1,998
Clinical Laboratory	5,694	3,557	$42.24	47
Endocrinology	739	506	$51.33	17
Diagnostic Radiology	103	82	$34.00	3
Gastroenterology	62	47	$22.44	1
Internal Medicine	58	55	$56.72	2
Dermatology	43	31	$33.57	1
Emergency Medicine	41	36	$34.80	1
Otolaryngology	13	11	$54.16	1

88172 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	10,819	$39.47	$27.78	188
New York	10,012	$44.82	$32.96	114
Texas	8,562	$34.73	$27.46	173
Illinois	7,684	$33.91	$26.22	143
Ohio	4,867	$34.38	$28.17	118
Florida	4,764	$37.62	$30.06	111
Pennsylvania	4,487	$33.92	$26.41	107
Tennessee	3,304	$38.00	$31.83	53
Colorado	2,923	$34.01	$26.18	68
New Jersey	2,744	$37.41	$27.19	46
South Carolina	2,724	$32.43	$26.59	47
Indiana	2,642	$35.85	$29.69	43
Virginia	2,533	$33.86	$27.01	57
North Carolina	2,496	$33.48	$27.21	60
Iowa	2,188	$33.13	$26.62	39
Massachusetts	2,150	$35.18	$26.19	60
Georgia	2,039	$33.51	$27.02	57
Arizona	1,902	$37.84	$30.15	45
Michigan	1,656	$33.06	$26.32	38
Missouri	1,655	$33.10	$26.39	42
Maryland	1,581	$35.40	$26.74	42
Kentucky	1,455	$32.64	$26.59	39
Louisiana	1,450	$32.37	$26.38	24
Wisconsin	1,358	$33.09	$26.50	32
Washington	1,272	$33.86	$26.34	37
Oklahoma	961	$38.40	$31.09	9
Minnesota	776	$33.18	$26.19	21
Delaware	745	$46.02	$36.63	12
Oregon	742	$38.03	$29.76	19
Vermont	707	$33.03	$25.69	12
District of Columbia	656	$39.06	$27.59	8
South Dakota	633	$32.39	$25.94	14
Hawaii	608	$35.85	$26.31	14
Mississippi	584	$35.25	$29.18	18
Connecticut	550	$34.29	$26.32	15
Nebraska	526	$31.92	$26.20	14
North Dakota	520	$33.02	$26.16	10
Maine	518	$33.21	$25.90	14
Kansas	506	$32.47	$26.28	17
Arkansas	441	$32.50	$26.53	10
Alabama	382	$31.93	$26.30	13
Nevada	345	$29.36	$25.90	11
Montana	264	$32.86	$26.42	8
Puerto Rico	229	$41.38	$32.65	7
Idaho	227	$32.02	$26.43	8
New Mexico	194	$32.85	$26.28	6
Utah	191	$33.82	$26.41	7
Rhode Island	184	$38.49	$29.12	7
New Hampshire	156	$33.97	$26.57	6
West Virginia	131	$32.64	$26.52	5
Alaska	79	$44.57	$26.88	2
Wyoming	53	$33.64	$26.37	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
88184Flow cytometry technique for dna or cell analysis$81.32
88120Cell examination of urine$465.04
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.