How much does Medicare pay for CPT 89055?

Medicare allowed an average of $4.18 per service and paid $4.18 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $51.77, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 89055?

White blood cell measure, stool specimen. It was billed 29,983 times to 29,190 Medicare beneficiaries by 100 providers in 2024.

Which specialty bills 89055 most?

Clinical Laboratory, with 28,156 services from 91 clinicians. Next are Pathology, Gastroenterology, General Practice.

CPT 89055

White blood cell measure, stool specimen

$4.18Medicare-allowed amount per service, averaged across 29,983 services

Providers submitted

$51.77

Asking price, not received

Medicare allowed

$4.18

The fee schedule figure

Medicare paid

$4.18

Balance is patient coinsurance

Providers submitted an average of $51.77 for this code and Medicare allowed $4.18 — 12.4× 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 $4.18 (100%); the rest is the patient’s coinsurance and deductible.

Services: 29,983
Beneficiaries: 29,190
Providers billing it: 100
Total allowed: $125,329

What Medicare pays for CPT 89055

Across 29,983 services billed by 100 providers to 29,190 beneficiaries, Medicare allowed an average of $4.18 per service. 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 89055

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	28,156	27,403	$4.18	91
Pathology	1,738	1,702	$4.18	4
Gastroenterology	49	48	$4.18	4
General Practice	40	37	$4.18	1

89055 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	5,131	$4.18	$4.18	7
North Carolina	4,593	$4.18	$4.18	3
Texas	3,820	$4.18	$4.18	8
Florida	3,364	$4.18	$4.18	7
Alabama	2,250	$4.18	$4.18	4
California	2,120	$4.18	$4.18	11
Arizona	1,558	$4.18	$4.18	2
Tennessee	854	$4.17	$4.18	3
Massachusetts	807	$4.18	$4.18	3
Virginia	783	$4.18	$4.18	4
Ohio	753	$4.18	$4.18	4
Missouri	577	$4.18	$4.18	2
Washington	502	$4.18	$4.18	3
Illinois	480	$4.18	$4.18	3
Oklahoma	471	$4.18	$4.18	3
Pennsylvania	390	$4.18	$4.18	4
Maryland	284	$4.18	$4.18	1
New York	249	$4.16	$4.18	6
Mississippi	219	$4.18	$4.18	3
Nevada	167	$4.16	$4.18	3
Oregon	146	$4.18	$4.18	3
Colorado	96	$4.18	$4.18	1
Kansas	78	$4.18	$4.18	3
Indiana	70	$4.13	$4.18	1
Michigan	51	$4.18	$4.18	2
Louisiana	46	$4.18	$4.18	1
Rhode Island	41	$4.18	$4.18	1
Maine	27	$4.18	$4.18	1
Georgia	23	$4.18	$4.18	1
Nebraska	22	$4.01	$4.18	1
South Dakota	11	$3.91	$4.18	1

Related codes

89051Body fluid cell count$5.48
89060Crystal identification from tissue or body fluid$9.04
89050Body fluid cell count$4.63

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.