How much does Medicare pay for CPT 92920?

Medicare allowed an average of $406.19 per service and paid $322.90 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $2047.51, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 92920?

Balloon dilation of single coronary artery or branch. It was billed 2,812 times to 2,454 Medicare beneficiaries by 152 providers in 2024.

Does 92920 pay differently in an office than a hospital?

Yes. The allowed amount averaged $250.10 in an office setting and $406.91 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 92920 most?

Cardiology, with 1,372 services from 72 clinicians. Next are Interventional Cardiology, Internal Medicine, Ambulatory Surgical Center.

CPT 92920

Balloon dilation of single coronary artery or branch

$406.19Medicare-allowed amount per service, averaged across 2,812 services

Providers submitted

$2047.51

Asking price, not received

Medicare allowed

$406.19

The fee schedule figure

Medicare paid

$322.90

Balance is patient coinsurance

Providers submitted an average of $2047.51 for this code and Medicare allowed $406.19 — 5.0× 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 $322.90 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $250.10
Hospital / facility: $406.91

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 13 services were billed in an office setting and 2,799 in a facility.

Services: 2,812
Beneficiaries: 2,454
Providers billing it: 152
Total allowed: $1,142,206

What Medicare pays for CPT 92920

Across 2,812 services billed by 152 providers to 2,454 beneficiaries, Medicare allowed an average of $406.19 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 92920

Specialty	Services	Beneficiaries	Avg allowed	Providers
Cardiology	1,372	1,187	$362.03	72
Interventional Cardiology	1,307	1,140	$394.99	71
Internal Medicine	84	79	$384.85	5
Ambulatory Surgical Center	36	36	$2519.55	3
Undefined Physician type	13	12	$477.34	1

92920 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	518	$371.62	$284.33	22
New York	269	$489.81	$328.72	11
Texas	269	$532.69	$432.02	15
Florida	164	$432.19	$318.97	10
Arkansas	163	$382.34	$332.41	9
Washington	134	$385.81	$291.06	7
Maryland	112	$290.38	$222.70	5
Ohio	87	$346.24	$277.62	3
New Jersey	82	$366.78	$269.16	5
Arizona	77	$340.18	$274.19	4
Mississippi	72	$371.84	$301.26	5
Iowa	69	$350.51	$305.47	4
Oklahoma	62	$836.92	$701.88	5
Georgia	56	$375.38	$292.64	3
Massachusetts	55	$385.90	$299.37	3
Alabama	53	$382.07	$328.23	3
Missouri	50	$354.10	$289.78	3
Tennessee	48	$293.14	$268.69	3
Michigan	43	$441.59	$313.36	3
North Dakota	37	$333.90	$277.53	3
Virginia	36	$355.55	$308.76	2
Illinois	36	$390.74	$276.28	3
Delaware	34	$261.02	$206.47	1
North Carolina	33	$412.91	$351.14	3
West Virginia	30	$328.95	$251.82	2
Louisiana	29	$372.42	$304.97	2
Pennsylvania	23	$332.58	$236.23	1
Minnesota	22	$376.65	$317.65	1
Nevada	22	$335.81	$273.71	2
Colorado	21	$429.19	$344.82	1
South Carolina	19	$261.12	$222.65	1
Indiana	15	$402.18	$349.22	1
New Hampshire	14	$401.98	$341.60	1
New Mexico	13	$340.45	$248.12	1
Kansas	12	$344.99	$301.03	1
Wisconsin	11	$410.98	$366.25	1
South Dakota	11	$398.07	$329.90	1
District of Columbia	11	$537.70	$400.81	1

Related codes

92928Insertion of stents$525.63
92960External shock to heart to regulate heart beat$103.99
92978Ultrasound evaluation of heart blood vessel or graft$91.55
92979Ultrasound evaluation of heart blood vessel or graft$72.73
92972Shockwave destruction of calcified plaque in coronary artery accessed$141.81
92941Removal of plaque and blood clot$623.51
92933Removal of plaque$610.77
92943Removal of plaque$618.11
92950Manual attempt to restore blood circulation and breathing$178.69

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.