How much does Medicare pay for CPT 49594?

Medicare allowed an average of $802.78 per service and paid $636.27 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $3830.44, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 49594?

Initial repair of entrapped hernia of abdomen, 3-10 cm in length. It was billed 2,338 times to 2,329 Medicare beneficiaries by 152 providers in 2024.

Which specialty bills 49594 most?

General Surgery, with 1,872 services from 120 clinicians. Next are Ambulatory Surgical Center, Physician Assistant, Nurse Practitioner.

CPT 49594

Initial repair of entrapped hernia of abdomen, 3-10 cm in length

$802.78Medicare-allowed amount per service, averaged across 2,338 services

Providers submitted

$3830.44

Asking price, not received

Medicare allowed

$802.78

The fee schedule figure

Medicare paid

$636.27

Balance is patient coinsurance

Providers submitted an average of $3830.44 for this code and Medicare allowed $802.78 — 4.8× 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 $636.27 (79%); the rest is the patient’s coinsurance and deductible.

Services: 2,338
Beneficiaries: 2,329
Providers billing it: 152
Total allowed: $1,876,900

What Medicare pays for CPT 49594

Across 2,338 services billed by 152 providers to 2,329 beneficiaries, Medicare allowed an average of $802.78 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 49594

Specialty	Services	Beneficiaries	Avg allowed	Providers
General Surgery	1,872	1,866	$679.52	120
Ambulatory Surgical Center	222	220	$2518.79	15
Physician Assistant	152	151	$92.43	11
Nurse Practitioner	54	54	$97.81	3
General Practice	15	15	$770.35	1
Colorectal Surgery (Proctology)	12	12	$646.84	1
Orthopedic Surgery	11	11	$638.16	1

49594 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	348	$673.82	$513.89	22
Florida	331	$874.30	$662.08	24
Arizona	230	$776.49	$619.66	12
Texas	225	$857.67	$703.99	15
New York	204	$985.50	$627.31	11
New Jersey	136	$791.42	$592.51	7
Georgia	112	$497.63	$381.30	7
Maryland	88	$1461.79	$1138.97	6
South Carolina	87	$598.78	$491.03	5
Washington	69	$833.39	$682.66	4
Pennsylvania	64	$707.94	$527.03	5
Delaware	57	$993.50	$781.27	4
Illinois	57	$681.22	$444.42	4
Missouri	45	$649.23	$536.32	3
Tennessee	39	$615.58	$548.17	3
New Mexico	39	$319.70	$227.89	3
Oklahoma	30	$417.80	$345.60	2
Michigan	27	$777.09	$541.15	2
Mississippi	25	$702.72	$573.92	2
Kansas	23	$1509.01	$1269.17	2
Wisconsin	12	$622.44	$548.91	1
Alabama	12	$549.53	$533.16	1
Massachusetts	12	$674.40	$520.58	1
North Carolina	11	$677.81	$573.94	1
Indiana	11	$606.87	$582.71	1
Kentucky	11	$727.13	$570.99	1
Nevada	11	$610.90	$518.98	1
Ohio	11	$2593.52	$2120.91	1
Virginia	11	$638.16	$529.54	1

Related codes

49505Repair of groin hernia (5 years or older)$660.91
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.