How much does Medicare pay for HCPCS G0109?

Medicare allowed an average of $15.50 per service and paid $11.50 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $47.41, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code G0109?

Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes. It was billed 32,361 times to 4,134 Medicare beneficiaries by 132 providers in 2024.

Does G0109 pay differently in an office than a hospital?

Yes. The allowed amount averaged $15.50 in an office setting and $14.86 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 G0109 most?

Registered Dietitian or Nutrition Professional, with 21,978 services from 87 clinicians. Next are Endocrinology, Pharmacy, Internal Medicine.

HCPCS G0109

Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes

$15.50Medicare-allowed amount per service, averaged across 32,361 services

Providers submitted

$47.41

Asking price, not received

Medicare allowed

$15.50

The fee schedule figure

Medicare paid

$11.50

Balance is patient coinsurance

Providers submitted an average of $47.41 for this code and Medicare allowed $15.50 — 3.1× 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 $11.50 (74%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $15.50
Hospital / facility: $14.86

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. 32,331 services were billed in an office setting and 30 in a facility.

Services: 32,361
Beneficiaries: 4,134
Providers billing it: 132
Total allowed: $501,596

What Medicare pays for HCPCS G0109

Across 32,361 services billed by 132 providers to 4,134 beneficiaries, Medicare allowed an average of $15.50 per service. That is 7.8 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 G0109

Specialty	Services	Beneficiaries	Avg allowed	Providers
Registered Dietitian or Nutrition Professional	21,978	2,819	$15.45	87
Endocrinology	5,472	781	$15.57	25
Pharmacy	1,870	111	$15.59	2
Internal Medicine	1,250	130	$14.96	6
Physician Assistant	1,171	179	$16.71	5
Nurse Practitioner	319	75	$15.69	4
Family Practice	301	39	$14.72	3

G0109 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	5,307	$15.45	$11.12	14
Maryland	3,021	$15.99	$11.20	9
California	2,574	$17.40	$11.52	10
Missouri	1,981	$14.95	$11.29	4
North Carolina	1,903	$14.75	$11.35	7
Ohio	1,707	$14.78	$10.99	11
New Jersey	1,596	$15.75	$12.13	1
Illinois	1,406	$16.28	$11.77	7
Indiana	1,372	$14.65	$11.77	7
Georgia	1,367	$15.14	$10.93	10
Pennsylvania	1,296	$15.41	$11.45	7
Virginia	1,152	$15.95	$11.72	8
South Carolina	1,120	$14.86	$10.92	5
Kansas	981	$14.60	$10.88	3
Texas	923	$14.98	$11.92	4
Tennessee	892	$14.37	$11.53	4
Oklahoma	499	$14.49	$11.01	1
Delaware	481	$15.38	$11.52	1
Arkansas	454	$14.14	$10.36	2
Alaska	442	$19.92	$10.28	1
Hawaii	326	$16.25	$11.10	1
Mississippi	263	$14.27	$11.19	1
Wisconsin	232	$14.89	$9.85	1
Kentucky	206	$14.79	$11.62	3
Colorado	164	$15.80	$10.71	1
Minnesota	158	$15.37	$12.25	2
Alabama	156	$14.70	$11.36	1
Washington	117	$15.67	$12.26	1
New York	104	$17.14	$11.77	2
Iowa	70	$14.60	$9.86	1
Massachusetts	61	$15.93	$10.66	1
New Mexico	30	$14.86	$11.44	1

Related codes

G0103Prostate cancer screening; prostate specific antigen test (psa)$18.89
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

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.