How much does Medicare pay for HCPCS A4565?

Medicare allowed an average of $10.28 per service and paid $7.63 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $28.41, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code A4565?

Slings. It was billed 3,138 times to 3,097 Medicare beneficiaries by 166 providers in 2024.

Which specialty bills A4565 most?

Orthopedic Surgery, with 1,148 services from 54 clinicians. Next are Physician Assistant, Hand Surgery, Family Practice.

HCPCS A4565

Slings

$10.28Medicare-allowed amount per service, averaged across 3,138 services

Providers submitted

$28.41

Asking price, not received

Medicare allowed

$10.28

The fee schedule figure

Medicare paid

$7.63

Balance is patient coinsurance

Providers submitted an average of $28.41 for this code and Medicare allowed $10.28 — 2.8× 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 $7.63 (74%); the rest is the patient’s coinsurance and deductible.

Services: 3,138
Beneficiaries: 3,097
Providers billing it: 166
Total allowed: $32,259

What Medicare pays for HCPCS A4565

Across 3,138 services billed by 166 providers to 3,097 beneficiaries, Medicare allowed an average of $10.28 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 A4565

Specialty	Services	Beneficiaries	Avg allowed	Providers
Orthopedic Surgery	1,148	1,127	$10.28	54
Physician Assistant	564	562	$10.28	39
Hand Surgery	563	550	$10.23	16
Family Practice	470	469	$10.32	30
Emergency Medicine	137	137	$10.36	10
Internal Medicine	94	93	$10.35	6
Nurse Practitioner	89	88	$10.15	7
Pediatric Medicine	52	51	$10.36	3
Sports Medicine	21	20	$10.36	1

A4565 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
Maryland	508	$10.32	$7.40	32
Illinois	401	$10.23	$7.70	18
Florida	282	$10.34	$8.18	13
Nebraska	243	$10.27	$7.95	5
California	230	$10.28	$7.94	13
Kansas	164	$10.34	$8.04	6
Mississippi	136	$10.08	$7.09	9
Pennsylvania	131	$10.36	$7.11	8
Tennessee	127	$10.20	$7.83	6
Indiana	123	$10.35	$7.59	5
Virginia	118	$10.27	$7.56	9
Massachusetts	105	$10.34	$8.00	4
Texas	81	$10.24	$8.06	5
Minnesota	62	$10.09	$7.84	3
Louisiana	53	$10.36	$7.48	4
Ohio	51	$10.36	$7.43	3
Georgia	45	$10.12	$7.70	3
Iowa	43	$10.34	$8.05	3
New Jersey	38	$10.34	$8.02	3
New York	29	$10.35	$7.96	2
North Carolina	27	$10.04	$7.12	2
Wisconsin	25	$10.02	$7.66	2
Kentucky	24	$10.35	$7.90	2
Delaware	20	$10.38	$6.18	1
Alabama	19	$10.36	$7.37	1
Missouri	15	$10.34	$8.24	1
Oklahoma	14	$10.35	$7.65	1
Colorado	13	$10.35	$7.61	1
Washington	11	$9.85	$7.49	1

Related codes

A4562Pessary, reusable, non rubber, any type$66.33
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.