How much does Medicare pay for HCPCS G0179?

Medicare allowed an average of $40.20 per service and paid $30.42 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $84.48, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does G0179 pay differently in an office than a hospital?

Yes. The allowed amount averaged $40.19 in an office setting and $40.51 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 G0179 most?

Internal Medicine, with 144,552 services from 2,485 clinicians. Next are Family Practice, Nurse Practitioner, General Practice.

HCPCS G0179

Physician or allowed practitioner re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians a

$40.20Medicare-allowed amount per service, averaged across 396,309 services

Providers submitted

$84.48

Asking price, not received

Medicare allowed

$40.20

The fee schedule figure

Medicare paid

$30.42

Balance is patient coinsurance

Providers submitted an average of $84.48 for this code and Medicare allowed $40.20 — 2.1× 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 $30.42 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $40.19
Hospital / facility: $40.51

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 389,512 services were billed in an office setting and 6,797 in a facility.

Services: 396,309
Beneficiaries: 210,124
Providers billing it: 6,191
Total allowed: $15,931,622

What Medicare pays for HCPCS G0179

Across 396,309 services billed by 6,191 providers to 210,124 beneficiaries, Medicare allowed an average of $40.20 per service. That is 1.9 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 G0179

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	144,552	76,406	$41.53	2,485
Family Practice	119,144	62,176	$40.95	1,908
Nurse Practitioner	61,564	31,074	$32.75	1,050
General Practice	19,860	11,241	$43.36	121
Emergency Medicine	13,364	8,488	$43.93	64
Physician Assistant	5,800	3,238	$34.62	124
Geriatric Medicine	5,688	3,193	$43.08	127
Cardiology	4,470	1,824	$43.29	49
Pathology	2,350	1,517	$44.71	3
Obstetrics & Gynecology	1,830	698	$41.88	8
Preventive Medicine	1,798	1,110	$42.85	4
Neurology	1,794	1,033	$42.04	21
Physical Medicine and Rehabilitation	1,724	1,151	$42.86	19
General Surgery	1,683	1,113	$42.07	16
Nephrology	1,584	899	$44.53	18

G0179 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	88,579	$43.23	$30.71	600
Texas	83,036	$39.12	$30.12	1,062
Florida	41,195	$39.01	$29.98	784
Illinois	23,325	$41.73	$31.01	292
Oklahoma	17,192	$37.09	$29.40	281
New York	13,664	$46.26	$30.77	280
Tennessee	12,205	$37.50	$30.11	244
Louisiana	12,031	$37.85	$30.27	275
Ohio	10,574	$37.37	$28.43	192
Mississippi	10,567	$36.49	$30.26	229
Alabama	8,852	$37.04	$30.13	244
Nevada	8,070	$36.92	$29.69	66
Georgia	6,815	$40.23	$31.26	152
Massachusetts	6,000	$43.69	$30.12	176
North Carolina	5,534	$37.22	$29.18	166
Connecticut	4,387	$44.13	$30.61	77
Virginia	4,304	$39.26	$29.32	102
Pennsylvania	3,647	$42.14	$30.46	90
Indiana	3,577	$37.41	$29.74	59
Michigan	3,443	$38.63	$29.26	88
South Carolina	3,302	$38.02	$30.69	110
Colorado	3,174	$40.84	$31.42	15
New Jersey	2,573	$43.88	$30.94	51
Maryland	2,343	$41.86	$29.88	48
Arkansas	2,154	$37.13	$30.62	65
Arizona	2,015	$39.20	$30.42	56
Kansas	1,871	$36.03	$29.80	41
Utah	1,822	$35.79	$28.02	31
Washington	1,794	$41.50	$28.20	59
Kentucky	1,761	$37.52	$29.61	51
Minnesota	1,054	$39.17	$28.92	42
Wisconsin	942	$40.33	$30.67	20
Delaware	666	$40.28	$30.65	17
New Mexico	543	$36.83	$29.09	16
Iowa	452	$38.16	$29.51	15
Idaho	430	$38.43	$28.73	14
West Virginia	358	$39.01	$29.50	13
New Hampshire	326	$42.71	$30.70	11
Missouri	295	$37.91	$28.59	11
Oregon	246	$41.68	$28.60	8
District of Columbia	187	$47.67	$30.46	7
North Dakota	151	$42.29	$30.89	2
Rhode Island	144	$42.42	$31.80	4
Nebraska	137	$38.40	$29.85	5
Vermont	119	$41.45	$29.74	5
Alaska	109	$42.56	$27.82	4
Guam	83	$43.96	$30.82	3
XX	54	$46.37	$32.76	1
AP	50	$37.72	$31.67	1
Maine	42	$42.18	$31.11	2
Hawaii	39	$47.35	$28.23	1
Wyoming	38	$40.99	$28.47	1
Montana	22	$41.19	$32.84	1
AE	16	$49.82	$32.78	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
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.