How much does Medicare pay for HCPCS A4561?

Medicare allowed an average of $27.12 per service and paid $20.33 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $71.17, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code A4561?

Pessary, reusable, rubber, any type. It was billed 1,325 times to 1,075 Medicare beneficiaries by 54 providers in 2024.

Does A4561 pay differently in an office than a hospital?

Yes. The allowed amount averaged $27.12 in an office setting and $27.55 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 A4561 most?

Obstetrics & Gynecology, with 509 services from 23 clinicians. Next are Nurse Practitioner, Urology, Physician Assistant.

HCPCS A4561

Pessary, reusable, rubber, any type

$27.12Medicare-allowed amount per service, averaged across 1,325 services

Providers submitted

$71.17

Asking price, not received

Medicare allowed

$27.12

The fee schedule figure

Medicare paid

$20.33

Balance is patient coinsurance

Providers submitted an average of $71.17 for this code and Medicare allowed $27.12 — 2.6× 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 $20.33 (75%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $27.12
Hospital / facility: $27.55

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 1,310 services were billed in an office setting and 15 in a facility.

Services: 1,325
Beneficiaries: 1,075
Providers billing it: 54
Total allowed: $35,934

What Medicare pays for HCPCS A4561

Across 1,325 services billed by 54 providers to 1,075 beneficiaries, Medicare allowed an average of $27.12 per service. That is 1.2 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 A4561

Specialty	Services	Beneficiaries	Avg allowed	Providers
Obstetrics & Gynecology	509	422	$27.30	23
Nurse Practitioner	380	316	$26.90	13
Urology	227	198	$27.28	12
Physician Assistant	209	139	$26.92	6

A4561 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	316	$26.72	$20.61	9
Tennessee	169	$27.66	$20.59	4
Ohio	121	$27.38	$20.83	7
New Jersey	109	$26.81	$20.44	4
Colorado	78	$27.79	$19.31	3
Maryland	78	$26.22	$20.50	1
Pennsylvania	74	$26.82	$20.00	3
Florida	71	$27.65	$21.12	4
Texas	56	$27.65	$20.56	3
New York	33	$26.81	$20.43	2
Utah	32	$27.78	$19.69	2
North Carolina	30	$27.32	$21.73	2
Indiana	30	$27.55	$20.27	2
Wisconsin	21	$27.52	$21.72	1
Alabama	19	$27.67	$20.20	1
South Carolina	19	$27.64	$21.73	1
Mississippi	17	$27.69	$19.17	1
Illinois	15	$26.84	$18.83	1
Minnesota	13	$26.78	$21.72	1
Michigan	13	$27.59	$18.38	1
Massachusetts	11	$22.41	$19.86	1

Related codes

A4562Pessary, reusable, non rubber, any type$66.33
A4565Slings$10.28

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.