How Much Does Medicare Actually Pay Doctors?

Published February 2026 · 11 min read

Understanding the Medicare Fee Schedule

Medicare doesn't pay doctors whatever they ask. Every service has a fee schedule rate — the maximum Medicare will pay. Doctors submit charges (what they'd like to get paid), but Medicare pays the fee schedule amount, which is typically much less.

This creates what we call the markup ratio — the gap between what doctors charge and what Medicare actually pays. Across all providers, doctors submit charges averaging about 3x their actual Medicare reimbursement. Some specialties charge 5-10x what they receive.

Medicare typically pays about 80% of what private insurance pays for the same service. This is a key reason many providers limit the number of Medicare patients they accept.

Top 20 Specialties by Average Medicare Payment

This table shows the average annual Medicare payment per provider for the top 20 highest-paid specialties (minimum 100 providers). These figures represent 10 years of cumulative data (2014-2023), divided by provider count.

Why the Range Is So Wide

The gap between the highest and lowest-paid specialties reflects several factors:

• Procedure vs. cognitive services: Specialties that perform procedures (surgery, injections, imaging) earn far more per service than those focused on evaluation and management visits.
• Drug administration: Ophthalmology and oncology rank high partly because they administer expensive Part B drugs (like aflibercept at $1,850 per injection) and receive a markup on drug costs.
• Volume capacity: Some specialties can see more patients per day. Radiology and clinical labs process high volumes with lower per-unit costs but high total payments.
• Patient population: Specialties serving older, sicker Medicare beneficiaries naturally generate more claims per patient.

Submitted Charges vs. Actual Payments

One of the most striking aspects of Medicare billing is the gap between what providers charge and what they actually receive. Across all specialties, providers submitted $3223.5B in charges but received $854.8B in actual payments.

This doesn't mean Medicare is underpaying. The submitted charge is often a "sticker price" that no one actually expects to collect. It's a legacy of the fee-for-service system where providers set their own rates, and insurers (including Medicare) pay according to their own fee schedules.

Read more: The Medicare Markup Machine →

Medicare vs. Private Insurance

Medicare generally pays about 80% of what private insurance pays for the same service, according to analyses by the Medicare Payment Advisory Commission (MedPAC). For hospital services, the gap can be larger — hospitals receive roughly 50-60% of their private payer rates from Medicare.

This differential is a major factor in physician practice economics. Practices with a higher share of Medicare patients tend to have tighter margins, which may explain why some specialties limit the number of Medicare beneficiaries they accept.

The Lowest-Paid Specialties

At the other end of the spectrum, these specialties receive the lowest average Medicare payments per provider: