How much does Medicare pay for CPT 92928?

Medicare allowed an average of $525.63 per service and paid $417.46 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $2129.14, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 92928?

Insertion of stents with balloon dilation of coronary artery or branch, single artery or branch. It was billed 167,246 times to 136,998 Medicare beneficiaries by 5,030 providers in 2024.

Does 92928 pay differently in an office than a hospital?

Yes. The allowed amount averaged $568.82 in an office setting and $525.61 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 92928 most?

Interventional Cardiology, with 89,752 services from 2,605 clinicians. Next are Cardiology, Internal Medicine, Peripheral Vascular Disease.

CPT 92928

Insertion of stents with balloon dilation of coronary artery or branch, single artery or branch

$525.63Medicare-allowed amount per service, averaged across 167,246 services

Providers submitted

$2129.14

Asking price, not received

Medicare allowed

$525.63

The fee schedule figure

Medicare paid

$417.46

Balance is patient coinsurance

Providers submitted an average of $2129.14 for this code and Medicare allowed $525.63 — 4.1× 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 $417.46 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $568.82
Hospital / facility: $525.61

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. 86 services were billed in an office setting and 167,160 in a facility.

Services: 167,246
Beneficiaries: 136,998
Providers billing it: 5,030
Total allowed: $87,909,515

What Medicare pays for CPT 92928

Across 167,246 services billed by 5,030 providers to 136,998 beneficiaries, Medicare allowed an average of $525.63 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 92928

Specialty	Services	Beneficiaries	Avg allowed	Providers
Interventional Cardiology	89,752	73,153	$517.71	2,605
Cardiology	70,975	58,463	$519.38	2,218
Internal Medicine	4,701	3,874	$506.70	145
Peripheral Vascular Disease	343	293	$568.73	10
Ambulatory Surgical Center	342	271	$4097.52	9
Cardiac Surgery	249	207	$544.55	8
Hospitalist	227	193	$563.00	8
Undefined Physician type	168	134	$536.89	4
Advanced Heart Failure and Transplant Cardiology	122	99	$500.09	6
Clinical Cardiac Electrophysiology	120	108	$533.42	7
Interventional Radiology	112	96	$485.52	4
Vascular Surgery	68	50	$496.58	3
Adult Congenital Heart Disease	29	23	$530.91	1
Nuclear Medicine	20	18	$590.80	1
Emergency Medicine	18	16	$525.16	1

92928 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
Florida	15,133	$556.83	$410.28	398
Texas	12,884	$563.60	$453.88	425
California	12,659	$511.56	$397.97	380
New York	10,847	$612.61	$415.32	243
Illinois	7,049	$580.50	$424.40	212
Ohio	6,978	$507.74	$408.34	211
Pennsylvania	6,351	$523.18	$412.73	220
Georgia	4,699	$514.59	$404.24	148
New Jersey	4,615	$570.69	$420.18	172
Arizona	4,443	$514.35	$414.81	143
Virginia	4,314	$512.28	$408.80	128
Michigan	4,245	$547.16	$413.05	162
North Carolina	4,231	$488.62	$409.53	124
Missouri	4,192	$498.70	$404.91	135
Indiana	4,130	$470.46	$408.48	142
Tennessee	3,995	$474.13	$407.79	133
Arkansas	3,968	$510.51	$446.01	85
South Carolina	3,486	$485.90	$398.94	103
Washington	3,463	$497.20	$393.13	110
Massachusetts	3,144	$532.34	$408.99	104
Oklahoma	3,046	$499.10	$416.38	89
Kentucky	3,032	$502.42	$409.24	94
Wisconsin	2,592	$460.96	$400.93	82
Mississippi	2,494	$480.81	$401.59	70
Maryland	2,475	$548.43	$413.91	70
Alabama	2,439	$475.81	$412.99	83
Iowa	2,389	$563.69	$492.49	58
Minnesota	2,337	$468.20	$401.95	81
Louisiana	2,303	$497.42	$408.44	80
Kansas	2,251	$475.64	$413.43	59
Colorado	2,001	$503.00	$398.41	62
West Virginia	1,322	$512.38	$391.27	36
Utah	1,266	$479.76	$392.37	33
Nevada	1,248	$496.01	$401.56	40
Oregon	1,190	$493.37	$402.50	39
South Dakota	1,160	$468.89	$405.18	17
Nebraska	1,080	$461.59	$407.71	31
Connecticut	952	$558.73	$412.44	40
New Hampshire	927	$506.59	$407.42	25
North Dakota	838	$471.74	$402.43	17
Montana	838	$512.97	$408.07	17
Idaho	708	$455.34	$399.62	23
Delaware	610	$541.49	$431.66	21
New Mexico	592	$503.77	$393.39	16
Maine	464	$495.03	$405.10	17
Rhode Island	458	$505.93	$402.59	14
Alaska	385	$645.81	$399.17	9
Vermont	339	$477.84	$402.21	8
District of Columbia	283	$588.65	$420.43	8
Hawaii	204	$486.75	$402.58	9
Wyoming	178	$482.68	$380.36	3
Puerto Rico	19	$538.95	$435.66	1

Related codes

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
92920Balloon dilation of single coronary artery or branch$406.19
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.