How much does Medicare pay for HCPCS P9603?

Medicare allowed an average of $1.08 per service and paid $1.08 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1.74, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does P9603 pay differently in an office than a hospital?

Yes. The allowed amount averaged $1.08 in an office setting and $1.05 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 P9603 most?

Clinical Laboratory, with 49,378,236 services from 246 clinicians. Next are Pathology, Nurse Practitioner, Family Practice.

HCPCS P9603

Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled

$1.08Medicare-allowed amount per service, averaged across 49,474,872 services

Providers submitted

$1.74

Asking price, not received

Medicare allowed

$1.08

The fee schedule figure

Medicare paid

$1.08

Balance is patient coinsurance

Providers submitted an average of $1.74 for this code and Medicare allowed $1.08 — 1.6× 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 $1.08 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $1.08
Hospital / facility: $1.05

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. 37,540,970 services were billed in an office setting and 11,933,902 in a facility.

Services: 49,474,872
Beneficiaries: 646,028
Providers billing it: 280
Total allowed: $53,432,862

What Medicare pays for HCPCS P9603

Across 49,474,872 services billed by 280 providers to 646,028 beneficiaries, Medicare allowed an average of $1.08 per service. That is 76.6 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 P9603

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	49,378,236	643,577	$1.08	246
Pathology	39,350	804	$1.10	3
Nurse Practitioner	25,673	799	$1.11	16
Family Practice	15,653	68	$1.11	1
Internal Medicine	12,482	456	$1.11	7
Physician Assistant	2,525	277	$1.11	5
Interventional Cardiology	917	14	$1.10	1
Endocrinology	36	33	$1.09	1

P9603 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
Florida	12,769,237	$1.08	$1.08	28
Illinois	7,420,754	$1.10	$1.10	47
Ohio	3,614,304	$1.07	$1.07	8
California	3,025,867	$1.12	$1.12	21
New Jersey	2,888,573	$1.10	$1.10	11
Virginia	2,349,004	$1.09	$1.09	3
Texas	2,204,779	$1.09	$1.09	32
North Carolina	1,748,410	$1.10	$1.10	6
Nevada	1,548,310	$1.10	$1.10	5
Louisiana	1,497,891	$1.11	$1.11	7
Massachusetts	1,316,213	$1.10	$1.10	3
Georgia	1,171,340	$1.11	$1.11	5
Kentucky	1,026,779	$1.11	$1.11	3
Pennsylvania	946,681	$0.16	$0.16	7
Alabama	867,707	$1.11	$1.11	7
Missouri	838,238	$1.11	$1.11	6
Arizona	735,981	$1.08	$1.08	7
Oklahoma	709,023	$1.09	$1.09	4
Delaware	466,168	$1.11	$1.11	2
Maryland	455,731	$1.10	$1.10	2
Colorado	451,552	$1.11	$1.11	4
Tennessee	298,900	$1.10	$1.10	9
Arkansas	229,831	$1.06	$1.06	3
Kansas	136,412	$1.06	$1.06	5
North Dakota	131,372	$1.11	$1.11	1
Mississippi	103,655	$1.11	$1.11	2
Utah	92,390	$1.10	$1.10	3
Rhode Island	91,445	$0.97	$0.97	1
New York	89,097	$1.09	$1.09	3
Wisconsin	83,651	$1.07	$1.07	4
Michigan	51,984	$1.10	$1.10	5
Indiana	42,169	$1.11	$1.11	1
Washington	25,709	$1.11	$1.11	17
Oregon	23,281	$1.11	$1.11	3
South Carolina	13,770	$1.11	$1.11	1
Maine	6,798	$1.04	$1.04	1
Minnesota	1,478	$1.10	$1.11	1
West Virginia	348	$1.11	$1.11	1
Connecticut	38	$1.11	$1.11	1

Related codes

P9604Travel allowance one way in connection$11.14
P9612Catheterization for collection of specimen$8.30
P9615Catheterization for collection of specimen(s) (multiple patients)$8.34

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.