How much does Medicare pay for CPT 96004?

Medicare allowed an average of $109.60 per service and paid $84.12 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $433.69, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 96004?

Physician review of gait analysis test. It was billed 1,721 times to 1,522 Medicare beneficiaries by 30 providers in 2024.

Does 96004 pay differently in an office than a hospital?

Yes. The allowed amount averaged $109.61 in an office setting and $109.22 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 96004 most?

Neurology, with 831 services from 13 clinicians. Next are Podiatry, Family Practice, Physical Therapist in Private Practice.

CPT 96004

Physician review of gait analysis test

$109.60Medicare-allowed amount per service, averaged across 1,721 services

Providers submitted

$433.69

Asking price, not received

Medicare allowed

$109.60

The fee schedule figure

Medicare paid

$84.12

Balance is patient coinsurance

Providers submitted an average of $433.69 for this code and Medicare allowed $109.60 — 4.0× 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 $84.12 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $109.61
Hospital / facility: $109.22

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. 1,681 services were billed in an office setting and 40 in a facility.

Services: 1,721
Beneficiaries: 1,522
Providers billing it: 30
Total allowed: $188,622

What Medicare pays for CPT 96004

Across 1,721 services billed by 30 providers to 1,522 beneficiaries, Medicare allowed an average of $109.60 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 96004

Specialty	Services	Beneficiaries	Avg allowed	Providers
Neurology	831	785	$111.43	13
Podiatry	440	433	$107.60	10
Family Practice	196	145	$106.56	1
Physical Therapist in Private Practice	138	45	$106.77	1
Orthopedic Surgery	46	46	$108.09	2
Internal Medicine	28	28	$112.95	1
Neuropsychiatry	22	22	$121.05	1
Physical Medicine and Rehabilitation	20	18	$113.54	1

96004 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 York	366	$119.13	$78.30	1
Florida	279	$105.38	$81.29	4
California	239	$107.64	$81.62	3
Minnesota	195	$106.43	$81.52	6
Arizona	182	$105.55	$82.76	2
New Jersey	72	$113.96	$74.03	1
Montana	69	$108.55	$78.99	2
Wyoming	58	$108.62	$69.81	1
Georgia	57	$105.91	$82.74	2
West Virginia	52	$105.63	$81.84	1
Colorado	46	$104.08	$77.21	1
Washington	41	$110.97	$76.71	2
Pennsylvania	20	$113.54	$78.64	1
Illinois	18	$108.76	$74.82	1
Utah	15	$107.96	$77.49	1
Idaho	12	$102.12	$83.25	1

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.