How much does Medicare pay for CPT 97598?

Medicare allowed an average of $33.10 per service and paid $26.20 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $99.74, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 97598?

Removal of tissue from wound, each additional 20.0 sq cm. It was billed 69,116 times to 7,840 Medicare beneficiaries by 383 providers in 2024.

Does 97598 pay differently in an office than a hospital?

Yes. The allowed amount averaged $41.96 in an office setting and $22.89 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 97598 most?

Family Practice, with 16,627 services from 91 clinicians. Next are General Surgery, Podiatry, Nurse Practitioner.

CPT 97598

Removal of tissue from wound, each additional 20.0 sq cm

$33.10Medicare-allowed amount per service, averaged across 69,116 services

Providers submitted

$99.74

Asking price, not received

Medicare allowed

$33.10

The fee schedule figure

Medicare paid

$26.20

Balance is patient coinsurance

Providers submitted an average of $99.74 for this code and Medicare allowed $33.10 — 3.0× 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 $26.20 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $41.96
Hospital / facility: $22.89

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. 36,991 services were billed in an office setting and 32,125 in a facility.

Services: 69,116
Beneficiaries: 7,840
Providers billing it: 383
Total allowed: $2,287,740

What Medicare pays for CPT 97598

Across 69,116 services billed by 383 providers to 7,840 beneficiaries, Medicare allowed an average of $33.10 per service. That is 8.8 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 97598

Specialty	Services	Beneficiaries	Avg allowed	Providers
Family Practice	16,627	1,714	$31.26	91
General Surgery	12,167	1,452	$32.98	74
Podiatry	12,014	1,066	$45.93	27
Nurse Practitioner	6,629	900	$21.88	55
Emergency Medicine	5,549	651	$24.38	35
Internal Medicine	3,197	405	$34.35	21
Physical Therapist in Private Practice	2,605	222	$41.69	6
Infectious Disease	1,196	121	$26.57	8
Physician Assistant	1,184	178	$20.32	11
General Practice	1,117	115	$43.72	7
Plastic and Reconstructive Surgery	1,103	180	$36.48	7
Vascular Surgery	972	147	$27.68	7
Cardiac Surgery	767	32	$23.20	2
Physical Medicine and Rehabilitation	669	128	$34.05	6
Occupational Therapist in Private Practice	555	140	$43.32	3

97598 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
California	16,074	$41.88	$30.51	30
Florida	6,687	$40.50	$31.40	51
Oklahoma	6,559	$31.14	$26.19	11
Pennsylvania	4,457	$26.38	$20.54	30
Texas	3,320	$33.95	$27.52	29
Illinois	2,637	$31.04	$23.37	23
Iowa	2,619	$20.97	$19.61	10
New Jersey	2,360	$28.07	$20.49	11
New York	2,223	$40.21	$29.54	16
Virginia	1,928	$26.64	$20.81	12
Massachusetts	1,854	$33.77	$24.91	13
Georgia	1,773	$24.02	$19.16	14
Kentucky	1,654	$28.36	$23.20	10
Missouri	1,466	$28.09	$22.57	12
Delaware	1,418	$23.58	$18.65	4
Tennessee	1,289	$26.64	$23.04	12
Maryland	1,232	$34.53	$24.91	11
South Carolina	1,097	$31.89	$25.27	11
Indiana	1,047	$28.22	$23.27	10
Wisconsin	940	$33.42	$27.87	7
North Carolina	810	$28.22	$22.73	5
Kansas	715	$21.20	$17.88	7
New Mexico	665	$20.26	$15.97	2
Rhode Island	653	$28.81	$21.27	6
Connecticut	532	$24.25	$18.29	4
Ohio	454	$33.50	$27.16	5
Michigan	440	$20.81	$16.38	4
Washington	426	$22.25	$15.15	1
South Dakota	355	$21.98	$18.46	2
Wyoming	251	$29.05	$22.73	2
Arizona	223	$25.88	$20.63	5
Nevada	197	$37.93	$30.51	3
Minnesota	188	$35.69	$29.64	1
Oregon	131	$20.65	$15.48	2
Alabama	130	$27.25	$24.26	3
New Hampshire	129	$23.95	$17.43	1
Louisiana	77	$23.09	$18.95	1
West Virginia	70	$24.75	$19.05	1
Arkansas	36	$22.17	$18.95	1

Related codes

97530Therapy procedure$31.54
97535Training for self-care or home management$25.35
97597Removal of tissue from wound$74.53
97533Therapy procedure$52.00
97542Evaluation for wheelchair$23.83
97550Caregiver training in strategies and techniques to facilitate the pati$51.87
97537Training for community or work reintegration$24.91

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.