How much does Medicare pay for CPT 57260?

Medicare allowed an average of $551.79 per service and paid $437.12 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $2799.01, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 57260?

Plastic repair of vagina and tissue separating vagina, rectum, and bladder. It was billed 3,859 times to 3,852 Medicare beneficiaries by 203 providers in 2024.

Which specialty bills 57260 most?

Obstetrics & Gynecology, with 2,820 services from 147 clinicians. Next are Urology, Physician Assistant, Nurse Practitioner.

CPT 57260

Plastic repair of vagina and tissue separating vagina, rectum, and bladder

$551.79Medicare-allowed amount per service, averaged across 3,859 services

Providers submitted

$2799.01

Asking price, not received

Medicare allowed

$551.79

The fee schedule figure

Medicare paid

$437.12

Balance is patient coinsurance

Providers submitted an average of $2799.01 for this code and Medicare allowed $551.79 — 5.1× 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 $437.12 (79%); the rest is the patient’s coinsurance and deductible.

Services: 3,859
Beneficiaries: 3,852
Providers billing it: 203
Total allowed: $2,129,358

What Medicare pays for CPT 57260

Across 3,859 services billed by 203 providers to 3,852 beneficiaries, Medicare allowed an average of $551.79 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 57260

Specialty	Services	Beneficiaries	Avg allowed	Providers
Obstetrics & Gynecology	2,820	2,815	$589.01	147
Urology	379	378	$619.63	22
Physician Assistant	304	303	$75.80	15
Nurse Practitioner	152	152	$73.20	8
Ambulatory Surgical Center	132	132	$1169.13	8
Undefined Physician type	50	50	$577.41	2
Gynecological Oncology	22	22	$733.89	1

57260 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	373	$558.23	$433.56	18
Texas	350	$448.42	$352.72	20
California	286	$569.28	$419.59	14
Arizona	259	$353.77	$289.20	7
Pennsylvania	156	$612.96	$485.63	7
Ohio	144	$566.28	$456.30	9
New Jersey	135	$697.71	$506.62	7
Massachusetts	133	$611.43	$460.58	10
North Carolina	127	$741.82	$636.86	8
Kansas	127	$526.65	$453.86	6
New York	120	$805.56	$542.74	5
Virginia	114	$544.80	$431.66	7
South Carolina	111	$636.51	$511.34	6
Nebraska	110	$539.61	$456.36	6
Illinois	108	$445.80	$321.92	8
Maryland	94	$622.84	$471.56	5
Arkansas	93	$569.01	$497.28	3
Wisconsin	89	$327.33	$274.33	4
Georgia	88	$726.56	$557.71	3
Oklahoma	79	$581.24	$492.86	4
Washington	79	$649.85	$484.20	5
Indiana	75	$474.97	$391.23	4
Tennessee	72	$566.06	$485.30	4
Missouri	70	$578.09	$456.15	3
Kentucky	68	$429.11	$326.70	3
Colorado	57	$359.79	$271.05	3
Iowa	47	$478.45	$407.03	3
Alabama	43	$779.71	$746.14	3
District of Columbia	40	$522.60	$362.30	2
Connecticut	39	$629.55	$461.64	3
New Hampshire	30	$576.72	$463.82	2
Nevada	27	$335.18	$270.28	2
Oregon	26	$390.05	$303.42	2
North Dakota	16	$525.24	$430.81	1
West Virginia	16	$766.73	$580.68	1
Michigan	13	$564.03	$422.89	1
Minnesota	12	$632.45	$492.65	1
Utah	11	$642.96	$568.93	1
Delaware	11	$453.20	$361.94	1
Vermont	11	$464.45	$378.25	1

Related codes

57288Creation of sling around urethra in female to control leakage$577.84
57250Repair of herniated rectum into vaginal wall$337.21
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.