How much does Medicare pay for CPT 58558?

Medicare allowed an average of $907.32 per service and paid $716.57 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $5028.70, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 58558?

Biopsy of lining of uterus and/or removal of polyp using an endoscope. It was billed 8,145 times to 8,019 Medicare beneficiaries by 469 providers in 2024.

Does 58558 pay differently in an office than a hospital?

Yes. The allowed amount averaged $1310.79 in an office setting and $796.75 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 58558 most?

Obstetrics & Gynecology, with 4,527 services from 278 clinicians. Next are Ambulatory Surgical Center, Gynecological Oncology, Internal Medicine.

CPT 58558

Biopsy of lining of uterus and/or removal of polyp using an endoscope

$907.32Medicare-allowed amount per service, averaged across 8,145 services

Providers submitted

$5028.70

Asking price, not received

Medicare allowed

$907.32

The fee schedule figure

Medicare paid

$716.57

Balance is patient coinsurance

Providers submitted an average of $5028.70 for this code and Medicare allowed $907.32 — 5.5× 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 $716.57 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $1310.79
Hospital / facility: $796.75

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. 1,752 services were billed in an office setting and 6,393 in a facility.

Services: 8,145
Beneficiaries: 8,019
Providers billing it: 469
Total allowed: $7,390,121

What Medicare pays for CPT 58558

Across 8,145 services billed by 469 providers to 8,019 beneficiaries, Medicare allowed an average of $907.32 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 58558

Specialty	Services	Beneficiaries	Avg allowed	Providers
Obstetrics & Gynecology	4,527	4,445	$604.69	278
Ambulatory Surgical Center	2,699	2,685	$1577.85	139
Gynecological Oncology	814	804	$347.47	49
Internal Medicine	72	52	$1160.73	1
Nurse Practitioner	17	17	$1070.49	1
Cardiology	16	16	$590.60	1

58558 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
California	1,176	$1207.40	$797.38	60
Florida	1,132	$796.52	$654.72	62
New York	741	$959.88	$671.90	45
Maryland	667	$789.08	$605.67	37
Texas	398	$1217.57	$1014.51	22
Pennsylvania	391	$707.55	$575.94	26
Massachusetts	383	$812.36	$628.53	22
New Jersey	304	$1135.29	$852.79	15
Virginia	220	$584.08	$476.55	15
Arizona	218	$909.45	$757.82	11
Illinois	192	$865.85	$670.88	12
Tennessee	189	$855.58	$755.48	8
Minnesota	178	$648.61	$504.10	8
North Carolina	162	$1084.79	$915.21	10
Indiana	145	$1128.17	$910.96	8
Iowa	128	$602.74	$510.34	7
Washington	122	$853.63	$642.92	9
Delaware	113	$640.76	$508.56	7
Ohio	104	$545.80	$454.31	7
Missouri	101	$930.25	$761.21	6
Kentucky	95	$798.65	$669.23	6
South Carolina	75	$601.06	$527.94	6
Michigan	72	$741.28	$642.40	5
Kansas	68	$813.30	$688.53	5
Colorado	62	$644.74	$514.29	4
Oregon	59	$892.89	$680.41	4
Alaska	51	$1801.33	$1206.68	2
Louisiana	50	$1088.53	$996.23	2
Nevada	48	$1221.33	$991.84	4
Mississippi	46	$955.81	$875.76	3
Alabama	41	$681.57	$595.72	2
Montana	40	$1082.83	$921.89	3
New Mexico	39	$982.66	$823.22	3
Connecticut	38	$237.85	$170.54	3
Vermont	38	$664.58	$539.44	3
Nebraska	38	$621.92	$512.63	2
District of Columbia	38	$225.47	$163.68	2
Wisconsin	37	$1527.61	$1223.79	1
Georgia	35	$533.32	$445.80	3
Rhode Island	34	$229.55	$153.57	3
West Virginia	28	$198.21	$155.34	2
Arkansas	24	$1121.08	$1007.77	2
Wyoming	13	$1523.73	$1229.06	1
North Dakota	12	$1422.86	$1191.68	1

Related codes

58571Removal of uterus$691.64
58542Partial removal of uterus$432.12

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.