How much does Medicare pay for CPT 95991?

Medicare allowed an average of $88.54 per service and paid $67.31 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $360.73, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 95991?

Maintenance of spinal canal or brain drug infusion pump by health care professional. It was billed 4,327 times to 1,620 Medicare beneficiaries by 79 providers in 2024.

Does 95991 pay differently in an office than a hospital?

Yes. The allowed amount averaged $94.93 in an office setting and $39.70 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 95991 most?

Interventional Pain Management, with 1,213 services from 13 clinicians. Next are Nurse Practitioner, Pain Management, Physician Assistant.

CPT 95991

Maintenance of spinal canal or brain drug infusion pump by health care professional

$88.54Medicare-allowed amount per service, averaged across 4,327 services

Providers submitted

$360.73

Asking price, not received

Medicare allowed

$88.54

The fee schedule figure

Medicare paid

$67.31

Balance is patient coinsurance

Providers submitted an average of $360.73 for this code and Medicare allowed $88.54 — 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 $67.31 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $94.93
Hospital / facility: $39.70

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. 3,826 services were billed in an office setting and 501 in a facility.

Services: 4,327
Beneficiaries: 1,620
Providers billing it: 79
Total allowed: $383,113

What Medicare pays for CPT 95991

Across 4,327 services billed by 79 providers to 1,620 beneficiaries, Medicare allowed an average of $88.54 per service. That is 2.7 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 95991

Specialty	Services	Beneficiaries	Avg allowed	Providers
Interventional Pain Management	1,213	364	$100.98	13
Nurse Practitioner	803	293	$84.77	16
Pain Management	780	339	$83.01	17
Physician Assistant	546	207	$80.47	10
Anesthesiology	499	215	$69.59	12
Physical Medicine and Rehabilitation	311	124	$99.16	7
Neurosurgery	156	65	$105.05	3
Neurology	19	13	$99.67	1

95991 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	1,453	$93.90	$75.38	26
California	526	$80.65	$57.86	6
Texas	415	$106.73	$80.70	1
Virginia	316	$76.80	$59.11	8
Maryland	204	$80.08	$59.22	5
Pennsylvania	135	$87.48	$67.72	2
Ohio	135	$88.16	$70.54	3
Indiana	123	$85.03	$71.78	3
South Carolina	107	$82.86	$65.23	2
Washington	90	$36.19	$25.03	3
Tennessee	85	$85.35	$71.89	2
Alabama	83	$88.79	$84.41	1
Michigan	80	$105.36	$84.49	3
District of Columbia	77	$106.88	$71.47	1
Kentucky	70	$98.53	$85.50	1
Illinois	65	$96.66	$74.83	1
Kansas	61	$79.05	$70.36	3
Georgia	55	$97.89	$81.96	1
Massachusetts	51	$40.60	$27.88	1
Minnesota	43	$94.39	$59.86	1
Arkansas	39	$93.45	$87.76	1
Missouri	38	$37.60	$27.20	1
Utah	38	$88.29	$63.58	1
Louisiana	21	$98.60	$75.29	1
Colorado	17	$103.39	$86.14	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.