How much does Medicare pay for CPT 49591?

Medicare allowed an average of $463.16 per service and paid $363.81 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $2632.50, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 49591?

Initial repair of sliding hernia of abdomen, less than 3 cm in length. It was billed 1,729 times to 1,727 Medicare beneficiaries by 118 providers in 2024.

Which specialty bills 49591 most?

General Surgery, with 1,296 services from 90 clinicians. Next are Ambulatory Surgical Center, Physician Assistant, Nurse Practitioner.

CPT 49591

Initial repair of sliding hernia of abdomen, less than 3 cm in length

$463.16Medicare-allowed amount per service, averaged across 1,729 services

Providers submitted

$2632.50

Asking price, not received

Medicare allowed

$463.16

The fee schedule figure

Medicare paid

$363.81

Balance is patient coinsurance

Providers submitted an average of $2632.50 for this code and Medicare allowed $463.16 — 5.7× 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 $363.81 (79%); the rest is the patient’s coinsurance and deductible.

Services: 1,729
Beneficiaries: 1,727
Providers billing it: 118
Total allowed: $800,804

What Medicare pays for CPT 49591

Across 1,729 services billed by 118 providers to 1,727 beneficiaries, Medicare allowed an average of $463.16 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 49591

Specialty	Services	Beneficiaries	Avg allowed	Providers
General Surgery	1,296	1,294	$265.09	90
Ambulatory Surgical Center	315	315	$1421.85	19
Physician Assistant	64	64	$34.16	5
Nurse Practitioner	24	24	$32.02	2
Urology	19	19	$164.17	1
General Practice	11	11	$298.49	1

49591 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	387	$566.28	$394.74	24
Florida	172	$372.11	$280.66	11
Ohio	105	$558.39	$473.08	6
New York	99	$270.39	$179.67	7
Maryland	80	$272.94	$203.37	6
Arizona	72	$612.59	$489.79	4
Texas	70	$235.51	$181.80	5
Illinois	70	$437.55	$322.84	6
Virginia	69	$305.56	$225.62	5
South Carolina	62	$558.99	$485.77	4
Utah	57	$572.20	$468.91	4
Pennsylvania	54	$298.50	$222.31	4
North Carolina	50	$611.89	$497.73	4
Mississippi	49	$232.26	$185.54	4
Kansas	43	$140.69	$122.77	3
Michigan	35	$284.84	$208.47	2
Nebraska	32	$906.16	$739.84	2
Colorado	31	$1299.97	$1071.45	2
Massachusetts	30	$312.37	$234.49	2
Tennessee	25	$1320.32	$1178.66	2
Nevada	23	$305.96	$246.86	2
Iowa	23	$149.58	$123.87	2
Georgia	22	$162.15	$124.39	2
Delaware	20	$193.18	$159.95	1
Vermont	14	$288.95	$248.08	1
Louisiana	12	$270.64	$214.74	1
Washington	12	$315.88	$239.22	1
Indiana	11	$1459.48	$1211.82	1

Related codes

49505Repair of groin hernia (5 years or older)$660.91
49594Initial repair of entrapped hernia of abdomen$802.78
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.