How much does Medicare pay for CPT 92511?

Medicare allowed an average of $110.35 per service and paid $82.71 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $337.68, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 92511?

Exam of the nose and throat using an endoscope. It was billed 24,099 times to 20,512 Medicare beneficiaries by 518 providers in 2024.

Does 92511 pay differently in an office than a hospital?

Yes. The allowed amount averaged $114.30 in an office setting and $36.05 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 92511 most?

Otolaryngology, with 18,052 services from 385 clinicians. Next are Physician Assistant, Nurse Practitioner, Allergy/ Immunology.

CPT 92511

Exam of the nose and throat using an endoscope

$110.35Medicare-allowed amount per service, averaged across 24,099 services

Providers submitted

$337.68

Asking price, not received

Medicare allowed

$110.35

The fee schedule figure

Medicare paid

$82.71

Balance is patient coinsurance

Providers submitted an average of $337.68 for this code and Medicare allowed $110.35 — 3.1× 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 $82.71 (75%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $114.30
Hospital / facility: $36.05

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. 22,882 services were billed in an office setting and 1,217 in a facility.

Services: 24,099
Beneficiaries: 20,512
Providers billing it: 518
Total allowed: $2,659,325

What Medicare pays for CPT 92511

Across 24,099 services billed by 518 providers to 20,512 beneficiaries, Medicare allowed an average of $110.35 per service. That is 1.2 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 92511

Specialty	Services	Beneficiaries	Avg allowed	Providers
Otolaryngology	18,052	15,572	$114.50	385
Physician Assistant	1,814	1,648	$92.62	63
Nurse Practitioner	1,575	1,192	$89.62	29
Allergy/ Immunology	780	542	$123.79	4
Radiation Oncology	700	495	$70.62	24
Plastic and Reconstructive Surgery	455	435	$116.52	2
Emergency Medicine	340	293	$129.74	1
Internal Medicine	128	123	$100.72	3
General Surgery	101	89	$131.50	2
Medical Oncology	69	47	$40.74	2
Cardiology	59	52	$135.88	1
Maxillofacial Surgery	26	24	$119.96	2

92511 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 York	3,141	$121.37	$80.04	51
Arizona	2,692	$110.35	$86.38	25
Florida	2,665	$113.04	$83.86	36
Texas	2,586	$101.74	$77.93	34
California	2,523	$127.50	$85.96	49
Georgia	1,407	$110.63	$83.37	27
New Jersey	1,304	$125.89	$83.19	39
Illinois	805	$105.21	$77.06	22
Massachusetts	783	$103.83	$70.32	30
North Carolina	682	$107.87	$84.27	15
Michigan	588	$111.77	$81.06	6
Ohio	443	$94.62	$74.43	20
Pennsylvania	432	$93.30	$72.97	14
Missouri	342	$77.52	$59.33	9
Iowa	322	$92.10	$75.48	7
Colorado	305	$108.31	$76.77	10
Maryland	277	$116.66	$83.46	9
Connecticut	254	$117.74	$82.72	10
Virginia	247	$82.11	$61.67	9
Louisiana	230	$92.24	$80.49	5
Washington	219	$106.77	$73.52	11
South Carolina	189	$104.86	$84.29	10
Alabama	180	$77.17	$68.83	5
Indiana	172	$90.64	$73.62	9
Oklahoma	158	$98.99	$76.37	7
Kentucky	143	$85.00	$64.51	8
Kansas	133	$80.13	$64.81	5
New Hampshire	117	$118.89	$83.17	3
Minnesota	116	$111.48	$84.31	3
Tennessee	95	$98.04	$87.83	5
New Mexico	76	$66.58	$47.92	3
Guam	63	$116.18	$77.87	1
Wisconsin	63	$106.29	$83.87	2
Vermont	62	$30.29	$23.15	3
Oregon	45	$117.68	$85.77	3
Arkansas	41	$99.75	$84.78	2
Idaho	36	$106.06	$79.47	1
Nevada	29	$114.59	$87.63	1
Rhode Island	28	$116.11	$82.68	2
Utah	27	$58.93	$39.90	2
Hawaii	24	$38.92	$29.47	1
Montana	18	$37.21	$29.46	1
Mississippi	13	$103.31	$91.40	1
Maine	13	$54.98	$39.35	1
District of Columbia	11	$134.26	$74.29	1

Related codes

92557Comprehensive hearing and speech recognition test$36.00
92567Test to assess middle ear function$15.98
92507Treatment of speech$72.06
92504Exam of ear using a microscope$26.45
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

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.