How much does Medicare pay for CPT 99195?

Medicare allowed an average of $93.96 per service and paid $67.80 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $266.00, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99195?

Drawing of blood for a medical problem. It was billed 41,241 times to 19,489 Medicare beneficiaries by 1,046 providers in 2024.

Which specialty bills 99195 most?

Hematology-Oncology, with 27,300 services from 721 clinicians. Next are Medical Oncology, Internal Medicine, Family Practice.

CPT 99195

Drawing of blood for a medical problem

$93.96Medicare-allowed amount per service, averaged across 41,241 services

Providers submitted

$266.00

Asking price, not received

Medicare allowed

$93.96

The fee schedule figure

Medicare paid

$67.80

Balance is patient coinsurance

Providers submitted an average of $266.00 for this code and Medicare allowed $93.96 — 2.8× 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 $67.80 (72%); the rest is the patient’s coinsurance and deductible.

Services: 41,241
Beneficiaries: 19,489
Providers billing it: 1,046
Total allowed: $3,875,004

What Medicare pays for CPT 99195

Across 41,241 services billed by 1,046 providers to 19,489 beneficiaries, Medicare allowed an average of $93.96 per service. That is 2.1 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 99195

Specialty	Services	Beneficiaries	Avg allowed	Providers
Hematology-Oncology	27,300	13,167	$95.40	721
Medical Oncology	6,490	3,139	$93.20	184
Internal Medicine	1,967	772	$98.07	37
Family Practice	1,380	260	$98.77	10
Hematology	932	428	$106.40	19
Nurse Practitioner	833	404	$76.64	28
Oral Surgery (Dentist only)	811	446	$103.68	12
Clinical Laboratory	626	353	$23.92	3
General Practice	196	92	$65.44	6
Hospitalist	115	72	$112.35	2
Nephrology	104	62	$66.36	3
Physician Assistant	89	41	$82.55	3
Urology	60	45	$85.61	3
Cardiology	56	36	$99.06	2
Gynecological Oncology	49	34	$91.23	2

99195 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	5,984	$107.56	$70.19	104
Florida	5,341	$91.22	$68.04	139
Texas	4,763	$89.11	$66.72	162
New York	4,275	$109.79	$68.34	99
Arizona	2,421	$74.79	$54.54	34
New Jersey	1,882	$105.95	$68.16	45
Virginia	1,653	$91.72	$65.52	47
Tennessee	1,264	$81.67	$67.04	33
Arkansas	1,092	$78.24	$68.62	23
Maryland	1,088	$101.41	$67.21	26
North Carolina	929	$87.67	$66.95	26
Pennsylvania	917	$98.85	$67.29	29
Nevada	917	$95.83	$66.87	22
Georgia	675	$84.01	$68.23	17
Michigan	651	$91.95	$66.11	22
Alabama	631	$77.64	$67.24	20
Illinois	519	$86.03	$65.62	15
Washington	422	$85.04	$58.18	14
Ohio	399	$86.97	$65.65	12
Kansas	398	$84.27	$66.86	11
Louisiana	394	$82.54	$67.86	10
South Carolina	384	$86.29	$66.85	12
Missouri	371	$85.30	$68.99	13
New Mexico	369	$86.79	$68.08	11
Colorado	335	$98.40	$66.28	12
Indiana	296	$85.33	$67.53	8
Utah	254	$82.23	$67.50	7
Oregon	250	$93.96	$66.20	11
Massachusetts	249	$100.00	$64.43	6
Nebraska	244	$84.04	$66.61	6
Connecticut	229	$98.13	$63.21	8
Hawaii	227	$106.41	$67.78	5
Kentucky	222	$65.58	$64.39	3
Mississippi	196	$81.96	$62.29	7
Idaho	168	$85.78	$64.01	3
Delaware	160	$97.44	$66.43	2
Oklahoma	104	$87.20	$69.53	3
Vermont	95	$91.47	$66.44	2
Wisconsin	73	$88.48	$65.89	2
Wyoming	70	$90.49	$60.20	2
Iowa	68	$86.47	$65.78	2
North Dakota	48	$94.68	$69.03	2
New Hampshire	48	$101.19	$64.21	2
Maine	47	$85.54	$66.17	2
Alaska	44	$94.14	$65.97	1
Minnesota	40	$91.53	$66.19	2
XX	19	$88.92	$53.04	1
West Virginia	16	$73.10	$53.44	1

Related codes

99152Use of a drug to induce depression of consciousness by physician perfo$15.74
99153Use of a drug to induce depression of consciousness by physician perfo$11.53
99183Management of oxygen chamber therapy$102.12
99157Use of a drug to induce depression of consciousness by physician not p$57.09
99156Use of a drug to induce depression of consciousness by physician not p$70.75

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.