How much does Medicare pay for CPT 57267?

Medicare allowed an average of $225.45 per service and paid $179.65 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $793.26, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 57267?

Insertion of artificial material for pelvic floor defect. It was billed 1,538 times to 1,213 Medicare beneficiaries by 56 providers in 2024.

Does 57267 pay differently in an office than a hospital?

Yes. The allowed amount averaged $236.79 in an office setting and $225.18 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 57267 most?

Obstetrics & Gynecology, with 869 services from 32 clinicians. Next are Urology, Undefined Physician type, Nurse Practitioner.

CPT 57267

Insertion of artificial material for pelvic floor defect

$225.45Medicare-allowed amount per service, averaged across 1,538 services

Providers submitted

$793.26

Asking price, not received

Medicare allowed

$225.45

The fee schedule figure

Medicare paid

$179.65

Balance is patient coinsurance

Providers submitted an average of $793.26 for this code and Medicare allowed $225.45 — 3.5× 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 $179.65 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $236.79
Hospital / facility: $225.18

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. 36 services were billed in an office setting and 1,502 in a facility.

Services: 1,538
Beneficiaries: 1,213
Providers billing it: 56
Total allowed: $346,742

What Medicare pays for CPT 57267

Across 1,538 services billed by 56 providers to 1,213 beneficiaries, Medicare allowed an average of $225.45 per service. That is 1.3 services per beneficiary, so this is a code patients typically receive more than once. 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 57267

Specialty	Services	Beneficiaries	Avg allowed	Providers
Obstetrics & Gynecology	869	666	$238.17	32
Urology	441	319	$241.99	15
Undefined Physician type	72	72	$244.03	2
Nurse Practitioner	70	70	$34.44	3
Physician Assistant	40	40	$33.19	2
Gynecological Oncology	31	31	$263.23	1
Colorectal Surgery (Proctology)	15	15	$239.18	1

57267 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	297	$234.90	$173.20	6
Texas	193	$209.09	$171.43	10
Maryland	135	$247.16	$194.65	2
New Jersey	120	$253.64	$194.34	4
Colorado	109	$176.81	$139.80	4
California	105	$207.70	$160.31	4
Missouri	102	$241.81	$194.31	3
Georgia	79	$247.63	$195.58	4
South Carolina	65	$235.66	$194.44	2
Michigan	59	$183.40	$139.77	2
Ohio	45	$240.53	$194.12	2
Illinois	39	$259.18	$194.60	1
Arizona	29	$241.35	$194.47	2
New York	28	$250.56	$194.23	2
North Carolina	27	$230.84	$193.98	1
Tennessee	25	$227.73	$194.56	1
Massachusetts	15	$134.97	$106.94	1
Louisiana	15	$219.96	$197.08	1
Alabama	15	$224.57	$194.26	1
Hawaii	13	$226.20	$197.21	1
Oregon	12	$31.79	$26.36	1
Indiana	11	$226.02	$193.82	1

Related codes

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