How much does Medicare pay for CPT 97813?

Medicare allowed an average of $46.52 per service and paid $36.15 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $118.74, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 97813?

Acupuncture with electrical stimulation, initial 15 minutes. It was billed 62,359 times to 10,181 Medicare beneficiaries by 248 providers in 2024.

Does 97813 pay differently in an office than a hospital?

Yes. The allowed amount averaged $46.76 in an office setting and $33.08 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 97813 most?

Physical Medicine and Rehabilitation, with 27,372 services from 89 clinicians. Next are Internal Medicine, Family Practice, Nurse Practitioner.

CPT 97813

Acupuncture with electrical stimulation, initial 15 minutes

$46.52Medicare-allowed amount per service, averaged across 62,359 services

Providers submitted

$118.74

Asking price, not received

Medicare allowed

$46.52

The fee schedule figure

Medicare paid

$36.15

Balance is patient coinsurance

Providers submitted an average of $118.74 for this code and Medicare allowed $46.52 — 2.6× 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 $36.15 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $46.76
Hospital / facility: $33.08

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. 61,287 services were billed in an office setting and 1,072 in a facility.

Services: 62,359
Beneficiaries: 10,181
Providers billing it: 248
Total allowed: $2,900,941

What Medicare pays for CPT 97813

Across 62,359 services billed by 248 providers to 10,181 beneficiaries, Medicare allowed an average of $46.52 per service. That is 6.1 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 97813

Specialty	Services	Beneficiaries	Avg allowed	Providers
Physical Medicine and Rehabilitation	27,372	4,254	$46.87	89
Internal Medicine	8,736	1,370	$47.71	36
Family Practice	8,559	1,445	$46.89	39
Nurse Practitioner	4,083	827	$40.84	20
Anesthesiology	2,891	375	$47.69	10
Pain Management	1,958	369	$45.11	9
Emergency Medicine	1,715	233	$46.32	6
Osteopathic Manipulative Medicine	1,468	254	$48.54	5
Neurology	1,386	229	$50.71	5
General Practice	1,243	200	$45.59	3
Physician Assistant	931	172	$38.47	8
Interventional Pain Management	830	224	$45.33	8
Cardiology	290	53	$49.12	1
Rheumatology	263	54	$50.97	2
General Surgery	233	61	$47.37	3

97813 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	15,956	$49.69	$34.53	55
New Jersey	9,589	$48.01	$34.91	30
California	9,587	$48.80	$33.92	39
Florida	4,224	$42.71	$33.51	9
Maryland	3,869	$46.74	$34.95	10
Wisconsin	1,990	$41.01	$33.00	9
Illinois	1,834	$43.61	$32.56	10
Colorado	1,688	$45.05	$32.11	5
South Carolina	1,636	$41.36	$32.98	3
Arizona	1,343	$40.23	$31.16	11
Connecticut	1,339	$45.05	$34.59	2
Pennsylvania	1,271	$45.81	$34.45	9
Nevada	1,104	$44.11	$34.58	1
Michigan	948	$45.04	$34.06	5
Virginia	940	$40.55	$29.85	5
Delaware	711	$44.79	$34.41	2
Washington	607	$41.18	$28.90	3
North Carolina	544	$37.74	$28.86	4
Georgia	520	$42.87	$33.81	5
Minnesota	498	$41.49	$31.08	9
Massachusetts	424	$45.83	$33.77	2
Ohio	376	$43.50	$33.42	5
Texas	340	$42.65	$33.87	3
Kentucky	208	$41.68	$34.03	2
South Dakota	181	$43.70	$32.28	1
Maine	151	$36.74	$29.08	2
Iowa	132	$39.12	$34.23	1
Indiana	115	$42.11	$34.02	1
Alabama	85	$41.06	$34.32	1
Idaho	60	$30.75	$24.78	1
Nebraska	38	$41.67	$34.15	1
Missouri	32	$41.42	$35.49	1
Tennessee	19	$29.96	$19.68	1

Related codes

97802Therapy procedure for nutrition management$30.60
97803Therapy procedure reassessment for nutrition management$26.85
97811Acupuncture, each additional 15 minutes$28.97
97814Acupuncture with electrical stimulation, each additional 15 minutes$37.95
97810Acupuncture, initial 15 minutes$39.49
97804Therapy procedure for nutrition management$13.75

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.