How much does Medicare pay for CPT 99304?

Medicare allowed an average of $76.99 per service and paid $59.75 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $177.13, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does 99304 pay differently in an office than a hospital?

Yes. The allowed amount averaged $76.66 in an office setting and $77.25 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 99304 most?

Podiatry, with 122,764 services from 952 clinicians. Next are Nurse Practitioner, Family Practice, Internal Medicine.

CPT 99304

Initial nursing facility care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes

$76.99Medicare-allowed amount per service, averaged across 313,203 services

Providers submitted

$177.13

Asking price, not received

Medicare allowed

$76.99

The fee schedule figure

Medicare paid

$59.75

Balance is patient coinsurance

Providers submitted an average of $177.13 for this code and Medicare allowed $76.99 — 2.3× 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 $59.75 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $76.66
Hospital / facility: $77.25

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 138,829 services were billed in an office setting and 174,374 in a facility.

Services: 313,203
Beneficiaries: 301,858
Providers billing it: 3,429
Total allowed: $24,113,499

What Medicare pays for CPT 99304

Across 313,203 services billed by 3,429 providers to 301,858 beneficiaries, Medicare allowed an average of $76.99 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 99304

Specialty	Services	Beneficiaries	Avg allowed	Providers
Podiatry	122,764	120,644	$80.01	952
Nurse Practitioner	84,472	81,854	$67.91	1,118
Family Practice	17,985	16,813	$77.97	351
Internal Medicine	15,703	14,482	$81.60	280
Physical Medicine and Rehabilitation	14,124	12,631	$84.25	125
Physician Assistant	11,408	11,172	$70.08	176
General Surgery	10,641	10,084	$82.99	105
Otolaryngology	6,696	6,621	$83.09	14
Psychiatry	4,539	3,977	$84.06	41
General Practice	4,204	4,078	$80.19	37
Infectious Disease	2,443	2,193	$80.94	19
Plastic and Reconstructive Surgery	1,953	1,948	$81.12	14
Geriatric Medicine	1,795	1,614	$82.00	24
Pulmonary Disease	1,502	1,357	$82.66	22
Emergency Medicine	1,455	1,409	$88.32	13

99304 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	49,012	$85.74	$59.97	340
Florida	40,951	$76.93	$59.20	376
California	37,941	$80.27	$58.73	283
New Jersey	30,265	$77.83	$56.27	296
Pennsylvania	16,710	$73.99	$57.02	214
Illinois	15,393	$74.07	$55.98	180
Texas	12,653	$72.69	$57.52	148
Ohio	10,798	$73.55	$57.54	183
Indiana	8,796	$70.05	$56.46	97
Maryland	8,754	$75.37	$55.83	108
Michigan	6,023	$75.48	$58.20	104
Connecticut	5,900	$76.65	$56.44	62
Massachusetts	5,842	$77.69	$58.09	71
Virginia	5,666	$70.28	$54.21	72
Missouri	5,097	$71.75	$55.93	78
Kentucky	3,984	$70.20	$56.81	50
South Carolina	3,836	$74.21	$59.07	37
Oklahoma	3,697	$71.16	$57.71	39
Georgia	3,406	$74.91	$58.39	44
North Carolina	3,381	$71.41	$58.05	54
Tennessee	2,619	$71.20	$58.34	51
Louisiana	2,609	$66.66	$52.83	42
Alabama	2,578	$74.85	$60.73	32
Kansas	2,450	$70.84	$56.96	34
Washington	2,441	$76.17	$57.34	37
Arizona	2,204	$74.82	$58.65	30
Minnesota	2,091	$73.78	$57.73	35
Mississippi	2,019	$66.57	$54.98	38
Utah	1,819	$69.32	$55.04	25
Delaware	1,400	$71.10	$56.69	15
Nevada	1,304	$69.68	$55.81	27
Iowa	1,256	$72.78	$55.74	31
Hawaii	1,091	$81.62	$56.94	7
New Hampshire	1,090	$74.27	$56.16	13
West Virginia	1,072	$70.49	$56.54	25
Wisconsin	1,007	$74.11	$59.58	24
Arkansas	904	$67.40	$55.14	22
Colorado	870	$74.17	$55.32	18
New Mexico	710	$75.15	$58.23	7
Maine	633	$76.03	$59.29	10
District of Columbia	412	$78.57	$56.99	8
Idaho	354	$68.59	$53.21	6
Montana	349	$90.11	$61.05	6
Vermont	341	$75.92	$61.03	6
Oregon	329	$75.71	$57.73	7
Rhode Island	303	$76.00	$58.47	12
Nebraska	244	$69.26	$54.25	9
North Dakota	219	$70.51	$55.95	6
AE	158	$69.94	$52.06	1
Wyoming	138	$78.24	$59.35	6
Alaska	38	$97.92	$54.26	1
South Dakota	32	$64.95	$51.40	1
Northern Mariana Islands	14	$75.91	$62.15	1

Related codes

99309Subsequent nursing facility care$96.76
99308Subsequent nursing facility care$68.91
99349Residence visit for established patient$111.27
99310Subsequent nursing facility care$136.30
99348Residence visit for established patient$69.57
99307Subsequent nursing facility care$38.21
99306Initial nursing facility care$173.94
99350Residence visit for established patient$162.36
99305Initial nursing facility care$126.36
99347Residence visit for established patient$42.71
99316Nursing facility discharge management$116.89
99344Residence visit for new patient$127.50

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.