How much does Medicare pay for CPT 96523?

Medicare allowed an average of $24.23 per service and paid $17.72 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $93.64, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 96523?

Irrigation of implanted venous access drug delivery device. It was billed 80,579 times to 36,027 Medicare beneficiaries by 1,594 providers in 2024.

Which specialty bills 96523 most?

Hematology-Oncology, with 58,949 services from 1,115 clinicians. Next are Medical Oncology, Internal Medicine, Nurse Practitioner.

CPT 96523

Irrigation of implanted venous access drug delivery device

$24.23Medicare-allowed amount per service, averaged across 80,579 services

Providers submitted

$93.64

Asking price, not received

Medicare allowed

$24.23

The fee schedule figure

Medicare paid

$17.72

Balance is patient coinsurance

Providers submitted an average of $93.64 for this code and Medicare allowed $24.23 — 3.9× 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 $17.72 (73%); the rest is the patient’s coinsurance and deductible.

Services: 80,579
Beneficiaries: 36,027
Providers billing it: 1,594
Total allowed: $1,952,429

What Medicare pays for CPT 96523

Across 80,579 services billed by 1,594 providers to 36,027 beneficiaries, Medicare allowed an average of $24.23 per service. That is 2.2 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 96523

Specialty	Services	Beneficiaries	Avg allowed	Providers
Hematology-Oncology	58,949	25,931	$24.37	1,115
Medical Oncology	14,710	6,569	$24.09	285
Internal Medicine	2,374	1,279	$23.96	65
Nurse Practitioner	1,572	784	$20.16	47
Hematology	1,091	478	$26.55	22
Gynecological Oncology	664	314	$24.69	19
Physician Assistant	565	329	$20.49	21
Radiation Oncology	209	118	$23.60	7
Hospitalist	152	70	$27.85	3
Family Practice	152	84	$23.27	5
General Surgery	56	14	$21.34	1
Hematopoietic Cell Transplantation and Cellular Therapy	35	26	$23.09	2
Anesthesiology	29	17	$23.24	1
Diagnostic Radiology	21	14	$23.23	1

96523 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
Texas	11,534	$23.58	$18.04	251
California	8,698	$29.68	$18.29	156
Maryland	4,599	$26.35	$18.02	70
Arizona	4,401	$23.92	$18.62	51
Florida	4,112	$24.04	$17.74	73
Tennessee	4,050	$21.95	$17.94	72
Illinois	3,499	$23.27	$17.77	85
Ohio	2,794	$21.99	$17.84	48
Kansas	2,464	$22.00	$17.28	21
Virginia	2,354	$24.19	$17.41	82
Pennsylvania	2,150	$24.60	$18.07	44
Nebraska	2,074	$22.20	$17.97	35
Nevada	1,939	$24.27	$17.86	41
New York	1,859	$25.91	$17.86	63
Indiana	1,846	$22.30	$17.49	28
Georgia	1,770	$22.02	$17.89	24
Michigan	1,609	$23.86	$17.63	35
New Jersey	1,592	$27.50	$17.82	38
Arkansas	1,538	$21.15	$17.98	34
Washington	1,457	$25.07	$17.00	40
Alabama	1,441	$21.28	$17.72	31
North Carolina	1,271	$22.90	$17.88	34
South Carolina	1,227	$23.00	$17.28	21
Missouri	1,136	$21.69	$17.53	19
Oklahoma	983	$22.01	$17.88	12
Colorado	983	$25.64	$18.39	32
Mississippi	927	$21.20	$17.96	11
Iowa	828	$22.35	$17.87	16
New Mexico	785	$22.65	$18.34	14
Connecticut	602	$26.42	$17.67	16
Louisiana	592	$21.93	$18.02	11
Massachusetts	461	$25.79	$17.18	11
Alaska	390	$26.09	$17.64	10
Utah	358	$22.22	$16.72	7
New Hampshire	322	$26.64	$18.98	2
Kentucky	318	$21.29	$17.39	8
Minnesota	277	$23.87	$17.99	11
West Virginia	233	$22.57	$19.18	2
Oregon	217	$25.14	$16.66	9
Wisconsin	206	$23.01	$17.80	7
Delaware	140	$25.55	$18.25	5
Vermont	111	$27.00	$18.12	1
Idaho	86	$22.81	$18.26	2
South Dakota	78	$24.31	$18.79	2
Puerto Rico	68	$24.45	$17.76	1
Maine	68	$24.87	$17.89	3
North Dakota	50	$20.77	$13.31	2
U.S. Virgin Islands	30	$25.93	$17.62	1
Wyoming	28	$25.59	$18.33	1
Rhode Island	24	$22.73	$19.45	1

Related codes

96574Application of light$269.07
96521Refilling and maintenance of portable pump$110.12
96567Application of light to destroy precancer skin growth$131.24
96573Application of light by qualified health care professional to destroy$214.12

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.