How much does Medicare pay for HCPCS G0019?

Medicare allowed an average of $78.48 per service and paid $62.08 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $188.52, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does G0019 pay differently in an office than a hospital?

Yes. The allowed amount averaged $78.70 in an office setting and $52.61 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 G0019 most?

Internal Medicine, with 1,531 services from 4 clinicians. Next are Family Practice, Nurse Practitioner, Hematology-Oncology.

HCPCS G0019

Community health integration services performed by certified or trained auxiliary personnel, including a community health worker, under the direction of a physician or other practitioner; 60 minutes per calendar month, in the following activities to addres

$78.48Medicare-allowed amount per service, averaged across 4,881 services

Providers submitted

$188.52

Asking price, not received

Medicare allowed

$78.48

The fee schedule figure

Medicare paid

$62.08

Balance is patient coinsurance

Providers submitted an average of $188.52 for this code and Medicare allowed $78.48 — 2.4× 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 $62.08 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $78.70
Hospital / facility: $52.61

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. 4,841 services were billed in an office setting and 40 in a facility.

Services: 4,881
Beneficiaries: 2,321
Providers billing it: 27
Total allowed: $383,061

What Medicare pays for HCPCS G0019

Across 4,881 services billed by 27 providers to 2,321 beneficiaries, Medicare allowed an average of $78.48 per service. That is 2.1 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 G0019

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	1,531	767	$79.93	4
Family Practice	1,362	777	$85.85	7
Nurse Practitioner	1,336	411	$67.42	11
Hematology-Oncology	384	173	$81.81	2
Infectious Disease	165	100	$89.02	1
Emergency Medicine	66	63	$74.66	1
Medical Oncology	37	30	$72.37	1

G0019 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	1,813	$75.88	$58.38	3
California	1,059	$88.40	$62.19	5
Texas	475	$80.17	$62.94	2
Louisiana	393	$74.06	$63.20	1
Wisconsin	325	$64.45	$53.69	1
New York	307	$84.15	$58.51	6
Arizona	218	$77.83	$62.88	1
South Carolina	96	$72.68	$61.89	3
Indiana	93	$73.44	$58.86	2
South Dakota	52	$66.13	$52.63	1
Virginia	27	$78.06	$63.15	1
Illinois	23	$70.24	$53.69	1

Related codes

G0008Administration of influenza virus vaccine$29.05
G0009Administration of pneumococcal vaccine$29.85
G0069Professional services for the administration of subcutaneous immunothe$29.26
G0022Community health integration services$52.97
G0068Professional services for the administration of anti-infective$78.73
G0010Administration of hepatitis b vaccine$30.96
G0070Professional services for the administration of intravenous chemothera$219.38
G0089Professional services$26.90
G0023Principal illness navigation services by certified or trained auxiliar$76.96
G0024Principal illness navigation services$51.25

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.