How much does Medicare pay for HCPCS A4562?

Medicare allowed an average of $66.33 per service and paid $49.77 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $127.40, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code A4562?

Pessary, reusable, non rubber, any type. It was billed 22,204 times to 17,730 Medicare beneficiaries by 725 providers in 2024.

Does A4562 pay differently in an office than a hospital?

Yes. The allowed amount averaged $66.33 in an office setting and $67.72 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 A4562 most?

Obstetrics & Gynecology, with 10,008 services from 353 clinicians. Next are Nurse Practitioner, Physician Assistant, Urology.

HCPCS A4562

Pessary, reusable, non rubber, any type

$66.33Medicare-allowed amount per service, averaged across 22,204 services

Providers submitted

$127.40

Asking price, not received

Medicare allowed

$66.33

The fee schedule figure

Medicare paid

$49.77

Balance is patient coinsurance

Providers submitted an average of $127.40 for this code and Medicare allowed $66.33 — 1.9× 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 $49.77 (75%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $66.33
Hospital / facility: $67.72

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 22,112 services were billed in an office setting and 92 in a facility.

Services: 22,204
Beneficiaries: 17,730
Providers billing it: 725
Total allowed: $1,472,791

What Medicare pays for HCPCS A4562

Across 22,204 services billed by 725 providers to 17,730 beneficiaries, Medicare allowed an average of $66.33 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 A4562

Specialty	Services	Beneficiaries	Avg allowed	Providers
Obstetrics & Gynecology	10,008	7,914	$65.98	353
Nurse Practitioner	6,823	5,529	$67.38	209
Physician Assistant	3,512	2,838	$65.73	103
Urology	1,268	967	$66.74	44
Undefined Physician type	246	207	$60.62	7
Certified Nurse Midwife	135	110	$60.11	5
Osteopathic Manipulative Medicine	101	69	$66.71	1
Certified Clinical Nurse Specialist	51	47	$68.39	1
Pediatric Medicine	38	28	$66.72	1
Gynecological Oncology	22	21	$66.76	1

A4562 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	2,106	$65.61	$51.64	57
Florida	1,749	$68.02	$51.02	62
New York	1,726	$66.29	$52.22	49
Texas	1,322	$68.53	$51.10	47
North Carolina	1,236	$68.57	$50.84	36
Massachusetts	1,115	$62.64	$52.87	31
Pennsylvania	1,101	$66.39	$51.29	33
Illinois	1,051	$65.02	$51.46	28
Virginia	1,044	$58.79	$45.18	25
Arizona	894	$66.41	$51.42	27
New Jersey	828	$64.86	$52.04	26
Tennessee	680	$68.03	$50.10	23
Ohio	679	$66.38	$50.06	28
Maryland	643	$65.66	$49.43	25
Indiana	553	$67.19	$50.78	16
Washington	520	$66.32	$49.97	20
South Carolina	423	$66.91	$49.92	13
Georgia	417	$66.80	$49.94	12
Iowa	410	$67.36	$48.97	13
Minnesota	400	$68.34	$49.89	16
Kentucky	387	$68.49	$48.54	12
Oregon	324	$66.43	$50.79	14
Kansas	321	$68.06	$51.19	12
Oklahoma	292	$68.50	$51.03	12
Missouri	230	$68.16	$50.02	8
Colorado	206	$68.51	$51.44	10
Nebraska	195	$68.32	$50.49	9
District of Columbia	166	$64.94	$52.75	7
Arkansas	146	$68.81	$50.41	6
Michigan	141	$68.36	$52.71	7
New Hampshire	138	$66.76	$51.53	5
Louisiana	129	$67.64	$47.58	5
Wisconsin	109	$68.44	$50.57	4
Mississippi	99	$68.82	$49.61	3
Hawaii	87	$64.44	$52.16	3
Montana	80	$69.15	$50.97	5
Connecticut	64	$65.04	$52.68	4
Delaware	54	$66.81	$49.21	3
Alabama	35	$68.74	$53.63	2
North Dakota	21	$69.15	$51.14	1
Guam	20	$66.96	$45.69	1
Alaska	15	$66.71	$54.06	1
Utah	13	$59.11	$50.58	1
Idaho	12	$61.91	$46.37	1
New Mexico	12	$68.73	$54.06	1
Wyoming	11	$69.29	$44.15	1

Related codes

A4565Slings$10.28
A4561Pessary, reusable, rubber, any type$27.12

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.