How much does Medicare pay for CPT 49505?

Medicare allowed an average of $660.91 per service and paid $519.67 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $3311.41, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 49505?

Repair of groin hernia (5 years or older). It was billed 14,533 times to 14,285 Medicare beneficiaries by 774 providers in 2024.

Does 49505 pay differently in an office than a hospital?

Yes. The allowed amount averaged $555.60 in an office setting and $662.19 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 49505 most?

General Surgery, with 10,591 services from 579 clinicians. Next are Ambulatory Surgical Center, Physician Assistant, Nurse Practitioner.

CPT 49505

Repair of groin hernia (5 years or older)

$660.91Medicare-allowed amount per service, averaged across 14,533 services

Providers submitted

$3311.41

Asking price, not received

Medicare allowed

$660.91

The fee schedule figure

Medicare paid

$519.67

Balance is patient coinsurance

Providers submitted an average of $3311.41 for this code and Medicare allowed $660.91 — 5.0× 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 $519.67 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $555.60
Hospital / facility: $662.19

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 services were billed in an office setting and 14,359 in a facility.

Services: 14,533
Beneficiaries: 14,285
Providers billing it: 774
Total allowed: $9,605,005

What Medicare pays for CPT 49505

Across 14,533 services billed by 774 providers to 14,285 beneficiaries, Medicare allowed an average of $660.91 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 49505

Specialty	Services	Beneficiaries	Avg allowed	Providers
General Surgery	10,591	10,524	$532.36	579
Ambulatory Surgical Center	2,400	2,227	$1527.91	106
Physician Assistant	795	791	$74.00	47
Nurse Practitioner	333	332	$69.51	19
Vascular Surgery	197	194	$538.01	8
General Practice	78	78	$513.42	5
Surgical Oncology	67	67	$571.14	5
Urology	29	29	$286.81	2
Cardiac Surgery	19	19	$631.66	1
Critical Care (Intensivists)	13	13	$525.11	1
Colorectal Surgery (Proctology)	11	11	$579.39	1

49505 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
California	1,954	$872.01	$604.38	99
Florida	1,184	$680.29	$531.04	51
New York	1,049	$615.59	$407.46	50
Massachusetts	893	$530.08	$395.46	35
Pennsylvania	877	$688.92	$529.96	41
Maryland	752	$648.33	$493.40	36
New Jersey	718	$666.96	$486.76	34
Texas	599	$600.86	$477.25	35
North Carolina	484	$518.71	$427.46	30
Virginia	450	$597.97	$459.57	26
Ohio	390	$590.34	$491.84	25
Arizona	379	$609.64	$488.46	17
Illinois	374	$643.02	$471.00	22
Georgia	349	$545.16	$432.36	21
South Carolina	335	$616.81	$517.86	20
Tennessee	324	$681.71	$598.61	20
Indiana	323	$725.40	$613.92	19
Oregon	285	$842.62	$643.46	13
Washington	282	$804.91	$607.01	15
Colorado	239	$774.90	$628.75	15
Missouri	207	$475.41	$377.22	12
Kansas	159	$518.58	$453.52	10
Arkansas	153	$718.93	$639.87	9
Louisiana	148	$504.08	$435.88	9
Nebraska	132	$782.24	$662.14	9
Utah	125	$559.60	$463.44	8
Oklahoma	122	$575.91	$469.37	8
Iowa	114	$516.74	$451.43	8
Connecticut	112	$577.98	$416.44	7
Michigan	107	$564.19	$397.89	7
Alabama	102	$696.90	$634.03	7
Kentucky	92	$798.42	$654.48	5
Wisconsin	91	$631.51	$554.48	7
North Dakota	86	$440.53	$367.30	6
Idaho	82	$520.31	$461.20	5
Vermont	70	$412.39	$343.56	5
Minnesota	53	$524.76	$408.63	4
South Dakota	47	$372.09	$334.73	4
New Hampshire	42	$514.34	$406.55	3
Rhode Island	41	$526.00	$410.04	2
Mississippi	36	$698.52	$690.62	3
Nevada	34	$523.26	$423.91	2
New Mexico	28	$505.80	$403.47	2
West Virginia	26	$523.07	$394.82	2
Alaska	25	$401.49	$257.48	2
Montana	25	$483.99	$392.60	2
District of Columbia	19	$564.07	$410.09	1
Delaware	15	$1556.51	$1175.79	1

Related codes

49594Initial repair of entrapped hernia of abdomen$802.78
49591Initial repair of sliding hernia of abdomen$463.16
49593Initial repair of sliding hernia of abdomen$538.47
49507Repair of trapped groin hernia (5 years or older)$735.60

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.