How much does Medicare pay for CPT 92504?

Medicare allowed an average of $26.45 per service and paid $19.43 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $83.94, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 92504?

Exam of ear using a microscope. It was billed 241,991 times to 181,962 Medicare beneficiaries by 2,919 providers in 2024.

Does 92504 pay differently in an office than a hospital?

Yes. The allowed amount averaged $28.01 in an office setting and $8.52 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 92504 most?

Otolaryngology, with 183,426 services from 2,120 clinicians. Next are Physician Assistant, Nurse Practitioner, Audiologist.

CPT 92504

Exam of ear using a microscope

$26.45Medicare-allowed amount per service, averaged across 241,991 services

Providers submitted

$83.94

Asking price, not received

Medicare allowed

$26.45

The fee schedule figure

Medicare paid

$19.43

Balance is patient coinsurance

Providers submitted an average of $83.94 for this code and Medicare allowed $26.45 — 3.2× 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 $19.43 (73%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $28.01
Hospital / facility: $8.52

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. 222,631 services were billed in an office setting and 19,360 in a facility.

Services: 241,991
Beneficiaries: 181,962
Providers billing it: 2,919
Total allowed: $6,400,662

What Medicare pays for CPT 92504

Across 241,991 services billed by 2,919 providers to 181,962 beneficiaries, Medicare allowed an average of $26.45 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 92504

Specialty	Services	Beneficiaries	Avg allowed	Providers
Otolaryngology	183,426	137,113	$27.76	2,120
Physician Assistant	30,286	23,197	$21.17	439
Nurse Practitioner	18,008	13,663	$20.94	283
Audiologist	8,336	6,441	$27.79	60
Neurology	571	522	$30.77	4
Family Practice	360	195	$28.16	3
Pain Management	332	308	$32.45	1
General Surgery	192	152	$26.35	1
Maxillofacial Surgery	152	108	$33.03	1
Ophthalmology	128	106	$30.20	2
Plastic and Reconstructive Surgery	74	63	$28.03	2
Osteopathic Manipulative Medicine	73	45	$27.26	1
Internal Medicine	32	32	$33.48	1
Pediatric Medicine	21	17	$26.11	1

92504 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	41,196	$29.74	$19.28	338
Florida	20,286	$26.53	$20.02	219
New York	17,384	$33.31	$21.34	173
Texas	16,458	$25.81	$19.64	237
New Jersey	10,100	$31.96	$20.90	68
Virginia	7,885	$27.52	$19.73	93
Maryland	7,261	$28.48	$19.99	59
Illinois	6,976	$23.32	$17.19	97
South Carolina	6,602	$24.41	$19.33	85
Colorado	6,453	$27.40	$19.46	53
Washington	6,255	$26.01	$17.77	101
Pennsylvania	6,148	$26.27	$19.17	83
Tennessee	6,117	$23.73	$19.13	65
Arizona	6,016	$25.68	$18.92	83
Ohio	5,452	$17.71	$13.73	83
Georgia	5,143	$24.91	$19.91	75
Massachusetts	4,763	$25.32	$16.73	59
North Carolina	4,728	$25.77	$19.85	97
Missouri	4,076	$23.04	$17.96	56
Kentucky	3,618	$23.88	$19.30	55
Iowa	3,581	$20.74	$16.04	51
Oregon	3,508	$24.20	$17.28	51
Wisconsin	3,451	$20.23	$14.81	55
Kansas	3,291	$23.53	$18.49	43
Minnesota	3,181	$24.14	$17.23	64
Michigan	3,100	$22.68	$17.43	50
District of Columbia	2,597	$27.30	$18.18	10
Indiana	2,512	$24.34	$20.12	34
Alabama	2,464	$24.64	$20.66	32
Nebraska	2,255	$22.75	$17.69	35
Oklahoma	2,002	$24.62	$19.76	33
Louisiana	1,475	$23.06	$18.65	20
Utah	1,417	$22.76	$16.66	29
South Dakota	1,412	$22.76	$16.89	21
West Virginia	1,319	$18.40	$14.37	19
Mississippi	1,225	$24.11	$20.25	25
Montana	1,070	$22.97	$15.62	12
Connecticut	1,034	$29.81	$19.89	19
New Hampshire	946	$13.25	$9.52	14
Arkansas	883	$24.61	$20.65	15
Idaho	851	$23.12	$18.29	14
New Mexico	816	$12.01	$9.14	13
Maine	650	$9.08	$6.62	11
North Dakota	649	$11.69	$8.49	14
Rhode Island	639	$28.09	$20.59	5
Vermont	603	$8.53	$5.97	9
Nevada	539	$28.04	$21.31	13
Delaware	371	$24.77	$18.08	5
Alaska	365	$30.19	$19.05	6
Hawaii	343	$29.95	$20.51	6
Wyoming	212	$27.59	$19.28	6
Guam	138	$28.80	$18.70	1
ZZ	88	$26.43	$22.77	1
U.S. Virgin Islands	68	$25.93	$20.20	3
Puerto Rico	19	$28.52	$22.61	1

Related codes

92557Comprehensive hearing and speech recognition test$36.00
92567Test to assess middle ear function$15.98
92507Treatment of speech$72.06
92526Treatment of swallowing and feeding disorder$84.14
92550Test for eardrum and muscle function$22.10
92588Placement of ear probe for computerized measurement of repeated sounds$33.35
92552Test for hearing various pitches$37.66
92540Evaluation and testing for balance$103.83
92556Test for ability to detect and repeat spoken words$43.60
92537Test to assess balance during warm and cool irrigation in both ears$38.90
92546Test for abnormal eye movement$131.13
92587Placement of ear probe for computerized measurement of sound$21.99

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.