How much does Medicare pay for HCPCS G0103?

Medicare allowed an average of $18.89 per service and paid $18.89 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $104.37, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code G0103?

Prostate cancer screening; prostate specific antigen test (psa). It was billed 1,369,803 times to 1,369,787 Medicare beneficiaries by 7,103 providers in 2024.

Which specialty bills G0103 most?

Clinical Laboratory, with 1,044,502 services from 332 clinicians. Next are Family Practice, Internal Medicine, Pathology.

HCPCS G0103

Prostate cancer screening; prostate specific antigen test (psa)

$18.89Medicare-allowed amount per service, averaged across 1,369,803 services

Providers submitted

$104.37

Asking price, not received

Medicare allowed

$18.89

The fee schedule figure

Medicare paid

$18.89

Balance is patient coinsurance

Providers submitted an average of $104.37 for this code and Medicare allowed $18.89 — 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 $18.89 (100%); the rest is the patient’s coinsurance and deductible.

Services: 1,369,803
Beneficiaries: 1,369,787
Providers billing it: 7,103
Total allowed: $25,875,579

What Medicare pays for HCPCS G0103

Across 1,369,803 services billed by 7,103 providers to 1,369,787 beneficiaries, Medicare allowed an average of $18.89 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 G0103

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	1,044,502	1,044,487	$18.90	332
Family Practice	136,335	136,334	$18.85	2,945
Internal Medicine	115,319	115,319	$18.86	2,261
Pathology	30,657	30,657	$18.86	40
Nurse Practitioner	15,849	15,849	$18.86	758
Physician Assistant	8,403	8,403	$18.85	364
Urology	6,140	6,140	$18.70	203
General Practice	2,202	2,202	$18.76	34
Cardiology	1,811	1,811	$18.90	23
Hematology-Oncology	1,548	1,548	$18.91	17
Pediatric Medicine	1,271	1,271	$18.79	15
Endocrinology	1,101	1,101	$18.83	27
Gastroenterology	1,080	1,080	$18.88	2
Emergency Medicine	898	898	$18.86	16
Geriatric Medicine	565	565	$18.83	11

G0103 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
Texas	148,668	$18.90	$18.91	605
North Carolina	131,662	$18.90	$18.91	478
Florida	115,704	$18.88	$18.90	536
New Jersey	99,485	$18.87	$18.88	61
California	89,959	$18.91	$18.92	104
Ohio	75,041	$18.88	$18.90	202
Tennessee	63,503	$18.87	$18.92	637
Alabama	55,295	$18.88	$18.91	250
Kansas	52,535	$18.91	$18.91	127
Arizona	52,141	$18.90	$18.92	158
Georgia	49,800	$18.89	$18.91	285
Illinois	39,459	$18.90	$18.92	148
Virginia	35,894	$18.91	$18.92	276
Massachusetts	27,553	$18.92	$18.92	173
New York	26,756	$18.86	$18.92	401
Pennsylvania	24,390	$18.89	$18.91	54
Wisconsin	24,311	$18.87	$18.92	100
Washington	24,119	$18.91	$18.92	134
South Carolina	19,202	$18.86	$18.91	179
Oklahoma	18,949	$18.90	$18.91	48
Colorado	17,177	$18.91	$18.91	73
Maryland	16,712	$18.90	$18.92	93
Oregon	16,440	$18.87	$18.92	93
Indiana	15,247	$18.83	$18.86	76
Minnesota	15,172	$18.74	$18.92	309
Louisiana	10,900	$18.87	$18.92	131
Iowa	10,715	$18.89	$18.91	151
Missouri	10,391	$18.89	$18.91	179
Michigan	10,325	$18.81	$18.85	113
Arkansas	9,262	$18.86	$18.92	153
Mississippi	8,869	$18.84	$18.92	115
Kentucky	8,323	$18.84	$18.92	85
Nebraska	7,082	$18.87	$18.91	97
Utah	6,161	$18.85	$18.92	120
Hawaii	5,071	$18.89	$18.92	2
Nevada	4,833	$18.91	$18.92	7
South Dakota	4,378	$18.88	$18.92	59
New Mexico	2,661	$18.86	$18.89	21
Montana	2,422	$18.89	$18.92	23
Rhode Island	2,074	$18.88	$18.92	4
Idaho	2,030	$18.91	$18.92	24
Maine	1,762	$18.92	$18.92	37
North Dakota	1,560	$18.87	$18.92	17
Connecticut	1,419	$18.92	$18.92	34
Alaska	1,412	$18.88	$18.92	42
West Virginia	944	$18.84	$18.90	24
New Hampshire	664	$18.92	$18.92	27
Wyoming	609	$18.83	$18.92	19
District of Columbia	301	$18.92	$18.92	5
U.S. Virgin Islands	232	$18.90	$18.92	2
Vermont	143	$18.92	$18.92	8
Puerto Rico	86	$18.39	$18.92	4

Related codes

G0127Trimming of dystrophic nails$17.81
G0180Physician or allowed practitioner certification for medicare-covered h$52.34
G0101Cervical or vaginal cancer screening; pelvic and clinical breast exami$37.86
G0181Physician or allowed practitioner supervision of a patient receiving m$103.01
G0179Physician or allowed practitioner re-certification for medicare-covere$40.20
G0105Colorectal cancer screening; colonoscopy on individual at high risk$287.76
G0145Screening cytopathology$25.95
G0121Colorectal cancer screening; colonoscopy on individual not meeting cri$295.44
G0136Administration of a standardized$16.63
G0108Diabetes outpatient self-management training services$53.63
G0123Screening cytopathology$19.83
G0109Diabetes outpatient self-management training services$15.50

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.