How much does Medicare pay for HCPCS M0010?

Medicare allowed an average of $71.22 per service and paid $71.22 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $96.52, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code M0010?

Enhancing oncology model (eom) monthly enhanced oncology services (meos) payment for eom enhanced services. It was billed 179,762 times to 30,147 Medicare beneficiaries by 853 providers in 2024.

Does M0010 pay differently in an office than a hospital?

Yes. The allowed amount averaged $71.17 in an office setting and $73.02 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 M0010 most?

Hematology-Oncology, with 132,223 services from 600 clinicians. Next are Medical Oncology, Internal Medicine, Hematology.

HCPCS M0010

Enhancing oncology model (eom) monthly enhanced oncology services (meos) payment for eom enhanced services

$71.22Medicare-allowed amount per service, averaged across 179,762 services

Providers submitted

$96.52

Asking price, not received

Medicare allowed

$71.22

The fee schedule figure

Medicare paid

$71.22

Balance is patient coinsurance

Providers submitted an average of $96.52 for this code and Medicare allowed $71.22 — 1.4× 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 $71.22 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $71.17
Hospital / facility: $73.02

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 174,789 services were billed in an office setting and 4,973 in a facility.

Services: 179,762
Beneficiaries: 30,147
Providers billing it: 853
Total allowed: $12,802,650

What Medicare pays for HCPCS M0010

Across 179,762 services billed by 853 providers to 30,147 beneficiaries, Medicare allowed an average of $71.22 per service. That is 6.0 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 M0010

Specialty	Services	Beneficiaries	Avg allowed	Providers
Hematology-Oncology	132,223	22,286	$71.26	600
Medical Oncology	37,006	5,943	$71.17	189
Internal Medicine	7,209	1,228	$70.86	39
Hematology	2,397	435	$71.35	10
Nurse Practitioner	369	117	$70.67	7
Physician Assistant	181	39	$70.22	2
Hematopoietic Cell Transplantation and Cellular Therapy	167	31	$71.77	1
Urology	117	41	$70.36	3
Gynecological Oncology	51	12	$68.60	1
Diagnostic Radiology	42	15	$70.70	1

M0010 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	41,198	$70.67	$68.56	240
Tennessee	23,264	$71.00	$68.55	89
Virginia	20,574	$70.39	$68.56	86
Arizona	11,749	$70.12	$68.57	53
Colorado	8,760	$71.32	$68.54	37
North Carolina	7,119	$71.57	$68.54	31
California	6,773	$78.04	$68.42	37
Washington	5,782	$71.03	$68.55	23
Florida	5,351	$71.23	$68.55	37
Georgia	5,233	$71.45	$68.54	20
Illinois	4,650	$71.39	$68.54	23
Arkansas	4,401	$71.47	$68.54	12
Oregon	4,268	$71.20	$68.55	27
South Carolina	4,238	$69.95	$68.57	6
Minnesota	4,130	$70.48	$68.56	21
Michigan	4,111	$72.12	$68.53	38
Ohio	3,168	$71.05	$68.55	15
Alabama	2,570	$71.85	$68.53	3
Missouri	2,011	$70.85	$68.55	6
Maryland	1,880	$74.32	$68.48	9
Indiana	1,638	$70.36	$68.56	8
Pennsylvania	1,570	$69.52	$68.58	4
Louisiana	1,255	$72.14	$68.53	5
Nevada	1,179	$74.83	$68.47	5
West Virginia	635	$77.03	$68.43	3
Iowa	438	$71.42	$68.54	1
Mississippi	348	$71.89	$68.53	1
Idaho	280	$71.44	$68.54	2
Connecticut	265	$70.71	$69.69	1
XX	259	$69.28	$68.59	1
New Mexico	180	$72.03	$68.53	3
Massachusetts	131	$70.40	$68.56	1
New York	115	$70.65	$68.56	1
Wisconsin	86	$73.39	$68.50	1
New Jersey	77	$73.56	$69.41	1
North Dakota	41	$68.60	$68.60	1
Kentucky	35	$73.64	$68.50	1

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.