How much does Medicare pay for CPT 49905?

Medicare allowed an average of $299.76 per service and paid $239.25 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1188.12, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 49905?

Repair of abdomen using abdominal lining graft. It was billed 1,771 times to 1,763 Medicare beneficiaries by 99 providers in 2024.

Which specialty bills 49905 most?

General Surgery, with 923 services from 52 clinicians. Next are Surgical Oncology, Colorectal Surgery (Proctology), Physician Assistant.

CPT 49905

Repair of abdomen using abdominal lining graft

$299.76Medicare-allowed amount per service, averaged across 1,771 services

Providers submitted

$1188.12

Asking price, not received

Medicare allowed

$299.76

The fee schedule figure

Medicare paid

$239.25

Balance is patient coinsurance

Providers submitted an average of $1188.12 for this code and Medicare allowed $299.76 — 4.0× 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 $239.25 (80%); the rest is the patient’s coinsurance and deductible.

Services: 1,771
Beneficiaries: 1,763
Providers billing it: 99
Total allowed: $530,875

What Medicare pays for CPT 49905

Across 1,771 services billed by 99 providers to 1,763 beneficiaries, Medicare allowed an average of $299.76 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 49905

Specialty	Services	Beneficiaries	Avg allowed	Providers
General Surgery	923	917	$323.52	52
Surgical Oncology	412	411	$320.50	22
Colorectal Surgery (Proctology)	214	213	$310.07	13
Physician Assistant	137	137	$51.81	7
Urology	58	58	$364.21	3
General Practice	14	14	$357.71	1
Nurse Practitioner	13	13	$49.07	1

49905 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
Florida	209	$246.86	$188.75	10
New Jersey	201	$271.52	$199.51	8
California	193	$313.78	$248.12	11
Illinois	188	$272.58	$184.82	5
New York	148	$400.10	$271.13	10
Maryland	109	$342.46	$269.14	5
South Carolina	70	$255.36	$228.80	5
Delaware	66	$280.56	$222.59	3
Texas	64	$345.45	$269.52	5
Ohio	61	$326.97	$262.77	4
Kentucky	55	$327.91	$273.02	4
North Carolina	54	$255.41	$219.84	4
Colorado	47	$341.52	$272.38	3
Alabama	41	$215.51	$189.02	2
Mississippi	38	$311.13	$273.71	3
Massachusetts	38	$362.57	$266.01	3
Tennessee	38	$253.06	$218.68	3
Nevada	30	$222.70	$180.91	2
Pennsylvania	29	$357.94	$268.48	2
Arkansas	27	$278.11	$246.72	2
Indiana	26	$310.51	$272.55	2
New Hampshire	15	$317.98	$255.26	1
District of Columbia	13	$377.25	$272.21	1
Utah	11	$333.67	$272.84	1

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.