How much does Medicare pay for CPT 95972?

Medicare allowed an average of $48.73 per service and paid $37.41 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $257.79, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does 95972 pay differently in an office than a hospital?

Yes. The allowed amount averaged $53.03 in an office setting and $38.58 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 95972 most?

Urology, with 5,170 services from 152 clinicians. Next are Anesthesiology, Pain Management, Obstetrics & Gynecology.

CPT 95972

Electronic analysis of implanted neurostimulator generator with complex spinal cord or peripheral nerve stimulator programming

$48.73Medicare-allowed amount per service, averaged across 20,144 services

Providers submitted

$257.79

Asking price, not received

Medicare allowed

$48.73

The fee schedule figure

Medicare paid

$37.41

Balance is patient coinsurance

Providers submitted an average of $257.79 for this code and Medicare allowed $48.73 — 5.3× 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 $37.41 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $53.03
Hospital / facility: $38.58

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. 14,146 services were billed in an office setting and 5,998 in a facility.

Services: 20,144
Beneficiaries: 13,809
Providers billing it: 564
Total allowed: $981,617

What Medicare pays for CPT 95972

Across 20,144 services billed by 564 providers to 13,809 beneficiaries, Medicare allowed an average of $48.73 per service. That is 1.5 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 95972

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	5,170	3,870	$49.25	152
Anesthesiology	2,835	1,608	$51.44	56
Pain Management	2,538	1,596	$50.77	71
Obstetrics & Gynecology	2,493	1,825	$47.63	67
Nurse Practitioner	2,347	1,556	$44.26	68
Interventional Pain Management	1,429	970	$51.26	42
Physician Assistant	1,201	866	$45.50	39
Physical Medicine and Rehabilitation	789	550	$47.64	27
Neurosurgery	583	408	$44.17	18
Sleep Medicine	164	87	$53.74	2
Neurology	136	97	$53.16	4
Colorectal Surgery (Proctology)	128	96	$53.03	5
General Surgery	124	98	$47.49	5
Undefined Physician type	76	74	$39.90	2
Orthopedic Surgery	67	52	$47.37	3

95972 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	3,036	$51.02	$38.35	78
Texas	2,339	$50.24	$38.67	67
California	1,990	$53.54	$39.32	38
Mississippi	1,048	$41.86	$34.98	19
Oklahoma	1,025	$46.84	$39.97	22
New York	966	$56.79	$40.50	18
South Carolina	862	$49.74	$38.87	20
Pennsylvania	812	$50.56	$37.75	21
Tennessee	654	$45.93	$37.39	26
Arizona	637	$46.28	$36.70	19
New Jersey	533	$55.94	$39.88	18
Kansas	487	$45.60	$38.35	13
Missouri	481	$44.50	$33.88	13
Illinois	474	$52.92	$39.27	19
Indiana	424	$38.57	$32.63	13
Virginia	364	$50.48	$38.97	6
North Carolina	356	$45.11	$36.67	14
Colorado	355	$44.93	$33.83	9
Ohio	340	$42.18	$33.62	17
Maryland	306	$53.25	$38.84	10
Washington	262	$44.50	$33.38	10
Kentucky	241	$42.89	$35.25	6
Massachusetts	230	$50.02	$37.39	10
Oregon	215	$47.26	$39.32	7
Michigan	193	$50.25	$37.27	5
Alabama	184	$44.68	$36.16	6
Louisiana	178	$42.73	$34.32	9
South Dakota	173	$34.53	$27.44	6
Nebraska	147	$39.42	$33.69	7
Arkansas	140	$35.81	$31.06	6
Georgia	138	$48.50	$37.72	7
Nevada	98	$40.06	$31.97	5
Minnesota	83	$46.20	$37.47	3
North Dakota	76	$41.87	$33.84	3
Utah	53	$42.48	$33.99	3
Iowa	48	$41.00	$34.82	3
New Hampshire	36	$53.77	$44.73	1
Connecticut	33	$52.39	$37.81	1
Wisconsin	29	$36.64	$27.94	1
Delaware	28	$36.95	$31.24	1
Idaho	23	$52.22	$36.53	1
New Mexico	19	$45.57	$36.26	1
Montana	16	$33.12	$24.65	1
West Virginia	12	$32.68	$26.40	1

Related codes

95911Nerve conduction$197.67
95910Nerve conduction$157.37
95938Placement of skin electrodes and measurement of stimulated sites on ar$55.24
95923Testing of autonomic (sympathetic) nervous system function$121.40
95909Nerve conduction$117.92
95992Repositioning exercises of head for treatment of dizziness$41.72
95913Nerve conduction$267.08
95912Nerve conduction$234.05
95921Testing of autonomic nervous system function and heart rate response t$87.65
95939Placement of skin electrodes and measurement of central motor stimulat$122.96
95984Electronic analysis of implanted brain$41.14
95983Electronic analysis of implanted brain$46.17

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.