How much does Medicare pay for HCPCS P9604?

Medicare allowed an average of $11.14 per service and paid $11.14 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $15.80, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does P9604 pay differently in an office than a hospital?

Yes. The allowed amount averaged $12.96 in an office setting and $7.04 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 P9604 most?

Clinical Laboratory, with 1,072,917 services from 267 clinicians. Next are Family Practice, Internal Medicine, Nurse Practitioner.

HCPCS P9604

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

$11.14Medicare-allowed amount per service, averaged across 1,082,276 services

Providers submitted

$15.80

Asking price, not received

Medicare allowed

$11.14

The fee schedule figure

Medicare paid

$11.14

Balance is patient coinsurance

Providers submitted an average of $15.80 for this code and Medicare allowed $11.14 — 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 $11.14 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $12.96
Hospital / facility: $7.04

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. 749,790 services were billed in an office setting and 332,486 in a facility.

Services: 1,082,276
Beneficiaries: 318,475
Providers billing it: 329
Total allowed: $12,056,555

What Medicare pays for HCPCS P9604

Across 1,082,276 services billed by 329 providers to 318,475 beneficiaries, Medicare allowed an average of $11.14 per service. That is 3.4 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 P9604

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	1,072,917	315,237	$11.15	267
Family Practice	4,866	1,194	$10.46	20
Internal Medicine	2,192	881	$7.73	8
Nurse Practitioner	1,039	571	$11.05	19
Endocrinology	475	170	$10.12	4
Emergency Medicine	235	160	$10.99	2
Interventional Cardiology	192	37	$11.05	1
Physician Assistant	180	125	$11.31	5
Pathology	153	81	$9.06	2
Nephrology	27	19	$13.87	1

P9604 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	243,853	$14.93	$14.94	15
Pennsylvania	135,167	$6.44	$6.44	13
California	132,988	$16.19	$16.19	33
Oklahoma	104,092	$10.84	$10.84	3
Florida	97,876	$9.84	$9.84	24
New Jersey	84,140	$6.94	$6.94	20
Massachusetts	41,057	$8.72	$8.72	8
Illinois	40,528	$10.17	$10.17	24
Texas	39,743	$9.05	$9.05	22
Arizona	34,353	$11.11	$11.11	3
Nevada	25,251	$11.26	$11.26	8
Ohio	17,453	$9.77	$9.77	6
Puerto Rico	9,762	$9.88	$9.88	59
Connecticut	9,610	$7.37	$7.37	4
Louisiana	8,264	$4.91	$4.91	4
Indiana	6,320	$10.96	$10.96	2
Maryland	6,038	$8.47	$8.47	1
Oregon	6,021	$5.74	$5.74	3
South Carolina	5,587	$7.82	$7.82	1
Michigan	5,279	$14.94	$14.94	4
Iowa	4,597	$6.25	$6.25	5
Colorado	3,716	$10.93	$10.93	5
Kansas	2,882	$12.16	$12.16	5
Kentucky	2,756	$11.07	$11.07	2
Missouri	2,251	$11.26	$11.26	3
Virginia	2,217	$8.09	$8.09	5
Delaware	1,500	$11.07	$11.07	1
North Dakota	1,365	$10.83	$10.83	9
Idaho	1,140	$2.97	$2.97	1
Wisconsin	1,040	$9.35	$9.35	5
Rhode Island	1,026	$3.36	$3.36	1
Georgia	810	$8.44	$8.44	4
Tennessee	756	$14.43	$14.43	5
Nebraska	667	$4.88	$4.88	5
Washington	665	$5.76	$5.76	5
North Carolina	601	$8.93	$8.93	4
Utah	298	$10.92	$10.92	1
Alabama	260	$12.33	$12.33	3
Minnesota	238	$4.28	$4.28	1
Maine	73	$4.13	$4.13	1
Arkansas	36	$11.07	$11.07	1

Related codes

P9603Travel allowance one way in connection$1.08
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.