How much does Medicare pay for CPT 93042?

Medicare allowed an average of $6.79 per service and paid $5.30 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $55.20, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 93042?

Electrocardiogram (ecg) 1 to 3 leads with review by physician only. It was billed 242,231 times to 206,256 Medicare beneficiaries by 2,817 providers in 2024.

Does 93042 pay differently in an office than a hospital?

Yes. The allowed amount averaged $7.12 in an office setting and $6.79 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 93042 most?

Emergency Medicine, with 173,508 services from 2,226 clinicians. Next are Cardiology, Physician Assistant, Internal Medicine.

CPT 93042

Electrocardiogram (ecg) 1 to 3 leads with review by physician only

$6.79Medicare-allowed amount per service, averaged across 242,231 services

Providers submitted

$55.20

Asking price, not received

Medicare allowed

$6.79

The fee schedule figure

Medicare paid

$5.30

Balance is patient coinsurance

Providers submitted an average of $55.20 for this code and Medicare allowed $6.79 — 8.1× 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 $5.30 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $7.12
Hospital / facility: $6.79

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. 2,903 services were billed in an office setting and 239,328 in a facility.

Services: 242,231
Beneficiaries: 206,256
Providers billing it: 2,817
Total allowed: $1,644,748

What Medicare pays for CPT 93042

Across 242,231 services billed by 2,817 providers to 206,256 beneficiaries, Medicare allowed an average of $6.79 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 93042

Specialty	Services	Beneficiaries	Avg allowed	Providers
Emergency Medicine	173,508	168,847	$6.83	2,226
Cardiology	30,955	10,021	$7.08	98
Physician Assistant	9,813	9,573	$5.83	214
Internal Medicine	6,754	4,421	$6.73	61
Pulmonary Disease	6,581	2,707	$6.78	17
Nurse Practitioner	4,707	4,264	$5.56	98
Interventional Cardiology	3,099	1,161	$7.10	10
Neurology	2,671	2,208	$6.78	36
Clinical Cardiac Electrophysiology	1,621	1,030	$6.57	15
Family Practice	1,580	1,200	$6.68	24
Hospitalist	219	157	$6.58	4
General Practice	180	175	$6.54	2
Medical Toxicology	100	100	$7.40	3
Nephrology	86	53	$6.42	1
Endocrinology	85	73	$7.34	1

93042 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	34,421	$6.88	$5.02	251
California	32,319	$6.98	$5.03	362
Illinois	27,668	$6.80	$5.10	269
Pennsylvania	21,495	$6.68	$5.10	166
New York	14,753	$7.40	$5.09	124
Florida	10,708	$6.97	$5.03	129
Massachusetts	9,283	$6.67	$5.01	82
Washington	9,066	$6.74	$4.99	161
Michigan	9,031	$6.66	$5.08	134
Maryland	7,760	$6.97	$4.94	92
Texas	7,625	$6.53	$5.14	100
Utah	6,952	$6.52	$4.94	126
Indiana	4,584	$6.35	$5.04	60
Colorado	3,889	$6.56	$4.92	70
Nebraska	3,292	$5.82	$4.76	32
Alabama	3,121	$6.04	$4.99	25
Georgia	2,993	$6.77	$5.12	36
Virginia	2,764	$6.58	$5.15	41
Ohio	2,713	$6.61	$5.03	56
Tennessee	2,678	$6.27	$5.06	56
Missouri	2,481	$6.49	$5.06	35
Arizona	2,188	$6.46	$4.86	52
Oklahoma	2,054	$6.33	$5.00	32
Delaware	1,950	$6.78	$5.07	17
Louisiana	1,799	$6.61	$5.11	22
Alaska	1,606	$8.83	$5.16	26
North Carolina	1,521	$6.42	$4.96	36
Minnesota	1,407	$6.43	$4.92	18
District of Columbia	1,301	$7.30	$5.08	23
Oregon	1,051	$6.70	$5.07	30
Rhode Island	947	$6.63	$5.17	11
Wisconsin	875	$6.56	$4.95	19
Mississippi	811	$6.19	$4.90	19
South Carolina	802	$6.48	$5.09	18
Connecticut	621	$7.34	$5.12	6
West Virginia	531	$6.67	$5.11	7
Nevada	451	$6.77	$5.09	21
New Mexico	449	$6.45	$4.73	9
Maine	395	$6.86	$5.03	4
Hawaii	354	$6.55	$4.85	9
Idaho	273	$6.46	$4.79	4
Kentucky	246	$6.32	$5.06	5
North Dakota	207	$6.42	$5.03	4
Wyoming	184	$6.42	$4.98	3
Montana	141	$8.98	$5.22	1
Kansas	124	$6.52	$4.89	4
Iowa	110	$5.98	$4.55	3
Arkansas	89	$6.64	$5.08	2
New Hampshire	87	$6.69	$4.86	2
South Dakota	29	$6.35	$5.22	1
Vermont	18	$7.35	$5.22	1
AP	14	$5.78	$4.44	1

Related codes

93010Routine electrocardiogram (ecg)$7.95
93000Routine electrocardiogram (ecg)$14.24
93018Exercise or drug-induced heart stress test$13.43
93015Exercise or drug-induced heart stress test$66.28
93016Exercise or drug-induced heart stress test$20.06
93005Routine electrocardiogram (ecg)$6.15
93040Electrocardiogram (ecg) 1 to 3 leads$13.18
93017Exercise or drug-induced heart stress test$31.71
93041Electrocardiogram (ecg) 1 to 3 leads$6.52
93050Analysis of central arterial pressure$14.83

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.