How much does Medicare pay for CPT 57250?

Medicare allowed an average of $337.21 per service and paid $267.87 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1913.73, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 57250?

Repair of herniated rectum into vaginal wall. It was billed 5,077 times to 5,069 Medicare beneficiaries by 252 providers in 2024.

Does 57250 pay differently in an office than a hospital?

Yes. The allowed amount averaged $367.56 in an office setting and $336.91 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 57250 most?

Obstetrics & Gynecology, with 3,448 services from 178 clinicians. Next are Urology, Physician Assistant, Nurse Practitioner.

CPT 57250

Repair of herniated rectum into vaginal wall

$337.21Medicare-allowed amount per service, averaged across 5,077 services

Providers submitted

$1913.73

Asking price, not received

Medicare allowed

$337.21

The fee schedule figure

Medicare paid

$267.87

Balance is patient coinsurance

Providers submitted an average of $1913.73 for this code and Medicare allowed $337.21 — 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 $267.87 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $367.56
Hospital / facility: $336.91

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 51 services were billed in an office setting and 5,026 in a facility.

Services: 5,077
Beneficiaries: 5,069
Providers billing it: 252
Total allowed: $1,712,015

What Medicare pays for CPT 57250

Across 5,077 services billed by 252 providers to 5,069 beneficiaries, Medicare allowed an average of $337.21 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 57250

Specialty	Services	Beneficiaries	Avg allowed	Providers
Obstetrics & Gynecology	3,448	3,442	$363.46	178
Urology	644	642	$344.54	26
Physician Assistant	417	417	$47.45	21
Nurse Practitioner	294	294	$53.30	14
Ambulatory Surgical Center	131	131	$1174.82	6
Undefined Physician type	96	96	$391.44	4
Colorectal Surgery (Proctology)	34	34	$166.94	2
Gynecological Oncology	13	13	$334.60	1

57250 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	516	$348.48	$276.64	24
California	494	$291.17	$214.62	21
Texas	398	$311.38	$254.08	19
Pennsylvania	296	$375.55	$284.17	12
Ohio	289	$321.81	$260.87	13
North Carolina	265	$308.13	$249.68	13
Nebraska	223	$435.09	$363.92	6
South Carolina	215	$308.09	$253.08	9
Tennessee	191	$397.47	$355.40	10
New Jersey	160	$262.31	$191.27	6
Arizona	146	$348.57	$283.69	10
Massachusetts	129	$372.31	$280.92	8
Alabama	127	$314.56	$276.20	6
Virginia	121	$401.60	$314.46	9
Kentucky	120	$319.57	$248.42	7
Colorado	114	$200.05	$156.67	5
Georgia	112	$362.67	$281.71	6
Oklahoma	104	$412.49	$346.40	7
Oregon	98	$227.55	$182.57	6
Indiana	97	$250.57	$216.35	5
Kansas	95	$320.88	$264.73	4
Michigan	92	$351.62	$270.18	5
Missouri	78	$315.84	$266.62	4
Wisconsin	70	$271.51	$223.79	4
Minnesota	64	$490.98	$393.75	5
Nevada	62	$248.03	$205.18	3
Mississippi	60	$628.28	$543.26	4
Washington	56	$418.62	$327.24	3
New Hampshire	51	$383.24	$303.95	3
Iowa	48	$432.69	$369.02	2
Illinois	41	$413.19	$314.89	3
Delaware	34	$338.24	$270.18	2
New York	34	$439.35	$291.82	2
Utah	14	$315.42	$259.62	1
North Dakota	14	$439.41	$382.98	1
Maryland	14	$363.08	$259.06	1
Idaho	12	$279.89	$241.26	1
Montana	12	$79.22	$38.49	1
Arkansas	11	$61.38	$35.99	1

Related codes

57288Creation of sling around urethra in female to control leakage$577.84
57260Plastic repair of vagina and tissue separating vagina$551.79
57282Repair of pelvic ligaments through vagina$657.07
57265Repair of bulging of rectum and bladder into vaginal wall$629.86
57283Repair of prolapsing vaginal vault through vagina$345.40
57267Insertion of artificial material for pelvic floor defect$225.45
57240Repair of bladder hernia into vaginal wall$442.59

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.