How much does Medicare pay for CPT 57425?

Medicare allowed an average of $767.24 per service and paid $607.91 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $2870.38, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 57425?

Surgical repair of vaginal defect using an endoscope. It was billed 8,664 times to 8,645 Medicare beneficiaries by 401 providers in 2024.

Does 57425 pay differently in an office than a hospital?

Yes. The allowed amount averaged $924.19 in an office setting and $766.18 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 57425 most?

Obstetrics & Gynecology, with 4,972 services from 232 clinicians. Next are Urology, Physician Assistant, Gynecological Oncology.

CPT 57425

Surgical repair of vaginal defect using an endoscope

$767.24Medicare-allowed amount per service, averaged across 8,664 services

Providers submitted

$2870.38

Asking price, not received

Medicare allowed

$767.24

The fee schedule figure

Medicare paid

$607.91

Balance is patient coinsurance

Providers submitted an average of $2870.38 for this code and Medicare allowed $767.24 — 3.7× 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 $607.91 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $924.19
Hospital / facility: $766.18

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. 58 services were billed in an office setting and 8,606 in a facility.

Services: 8,664
Beneficiaries: 8,645
Providers billing it: 401
Total allowed: $6,647,367

What Medicare pays for CPT 57425

Across 8,664 services billed by 401 providers to 8,645 beneficiaries, Medicare allowed an average of $767.24 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 57425

Specialty	Services	Beneficiaries	Avg allowed	Providers
Obstetrics & Gynecology	4,972	4,960	$887.40	232
Urology	1,794	1,790	$882.31	83
Physician Assistant	1,183	1,181	$129.14	53
Gynecological Oncology	293	293	$811.79	13
Nurse Practitioner	265	264	$120.57	13
Undefined Physician type	77	77	$1008.43	4
Ambulatory Surgical Center	42	42	$3024.89	1
Surgical Oncology	26	26	$906.03	1
Certified Clinical Nurse Specialist	12	12	$123.21	1

57425 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	983	$799.56	$606.28	44
Texas	839	$750.60	$581.77	30
California	545	$733.92	$525.10	26
Pennsylvania	354	$728.46	$556.55	17
New York	339	$766.35	$526.38	15
Colorado	304	$697.54	$523.87	12
North Carolina	277	$683.46	$539.16	14
New Jersey	276	$855.33	$618.90	10
Indiana	266	$770.89	$661.43	9
Virginia	253	$890.67	$702.22	13
Nebraska	251	$593.64	$516.35	9
Georgia	250	$921.18	$712.11	11
Tennessee	236	$834.24	$725.80	12
Arizona	227	$734.54	$599.71	14
Oklahoma	223	$835.78	$677.91	11
Michigan	179	$931.89	$712.41	8
Mississippi	176	$643.36	$521.34	4
South Carolina	172	$707.60	$570.68	9
Alabama	172	$735.08	$616.36	10
Oregon	165	$522.97	$399.03	10
Illinois	158	$1007.44	$737.95	8
Washington	155	$813.64	$573.91	8
Maryland	153	$959.06	$703.92	8
Ohio	145	$754.25	$624.95	8
Massachusetts	140	$876.61	$626.35	8
Arkansas	139	$777.31	$668.26	6
Missouri	135	$846.00	$685.05	7
Kansas	114	$914.86	$731.42	6
Utah	113	$557.44	$435.85	5
Nevada	111	$724.54	$586.14	5
Wisconsin	107	$678.95	$564.45	6
Delaware	83	$678.48	$515.28	3
Idaho	81	$684.83	$568.50	4
Minnesota	80	$604.86	$496.95	5
Louisiana	66	$633.73	$451.93	3
Montana	65	$819.05	$625.05	4
Kentucky	59	$670.93	$511.56	4
South Dakota	51	$496.50	$388.94	2
Alaska	43	$931.19	$523.14	2
Wyoming	40	$531.13	$424.72	2
West Virginia	36	$862.80	$735.66	2
Iowa	34	$837.24	$697.33	2
New Mexico	18	$947.49	$744.33	1
Connecticut	15	$153.66	$51.58	1
New Hampshire	13	$908.81	$732.32	1
District of Columbia	12	$1146.21	$761.53	1
Hawaii	11	$884.99	$760.21	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.