How much does Medicare pay for HCPCS G0180?

Medicare allowed an average of $52.34 per service and paid $40.35 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $124.96, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does G0180 pay differently in an office than a hospital?

Yes. The allowed amount averaged $52.33 in an office setting and $52.52 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 G0180 most?

Internal Medicine, with 265,786 services from 7,566 clinicians. Next are Family Practice, Nurse Practitioner, Orthopedic Surgery.

HCPCS G0180

Physician or allowed practitioner 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 and

$52.34Medicare-allowed amount per service, averaged across 695,422 services

Providers submitted

$124.96

Asking price, not received

Medicare allowed

$52.34

The fee schedule figure

Medicare paid

$40.35

Balance is patient coinsurance

Providers submitted an average of $124.96 for this code and Medicare allowed $52.34 — 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 $40.35 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $52.33
Hospital / facility: $52.52

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 646,367 services were billed in an office setting and 49,055 in a facility.

Services: 695,422
Beneficiaries: 572,857
Providers billing it: 18,598
Total allowed: $36,398,387

What Medicare pays for HCPCS G0180

Across 695,422 services billed by 18,598 providers to 572,857 beneficiaries, Medicare allowed an average of $52.34 per service. That is 1.2 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 G0180

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	265,786	217,224	$54.01	7,566
Family Practice	183,673	150,755	$52.85	5,690
Nurse Practitioner	87,618	70,399	$44.05	2,032
Orthopedic Surgery	40,734	38,450	$53.09	943
General Practice	20,413	15,074	$55.15	203
Emergency Medicine	13,166	11,062	$56.54	87
Geriatric Medicine	12,666	10,102	$55.16	327
Physical Medicine and Rehabilitation	12,473	11,817	$52.09	207
Physician Assistant	11,044	9,458	$44.68	339
Hospitalist	5,739	5,407	$54.16	212
Cardiology	4,445	3,149	$55.52	103
Neurology	3,823	2,874	$53.51	80
Infectious Disease	3,628	2,179	$49.95	110
General Surgery	3,326	2,607	$54.30	66
Podiatry	2,775	2,392	$54.67	94

G0180 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	118,438	$57.25	$40.20	1,479
Florida	115,336	$50.99	$39.27	2,398
Texas	49,534	$50.59	$39.72	1,500
Illinois	43,300	$53.73	$40.10	994
New York	28,184	$58.13	$40.05	751
Massachusetts	27,140	$55.37	$39.94	832
Ohio	20,970	$49.33	$39.31	762
Pennsylvania	20,757	$51.90	$40.34	805
Tennessee	18,116	$47.86	$39.35	551
Michigan	17,590	$50.65	$38.96	537
Virginia	16,906	$51.69	$39.17	566
North Carolina	15,446	$48.28	$38.75	622
Georgia	14,037	$50.96	$40.24	417
Alabama	13,093	$47.57	$39.78	493
New Jersey	12,596	$57.34	$40.70	391
Maryland	12,372	$54.66	$39.48	382
South Carolina	11,905	$48.93	$39.55	416
Oklahoma	11,893	$48.16	$39.29	392
Louisiana	11,190	$48.89	$40.14	443
Connecticut	10,395	$55.96	$39.92	339
Arizona	10,379	$49.99	$39.66	254
Mississippi	9,308	$47.30	$39.65	331
Nevada	9,206	$47.48	$38.07	115
Washington	8,807	$52.02	$37.75	265
Minnesota	7,242	$49.33	$37.78	281
Kentucky	6,505	$49.14	$39.39	236
Indiana	6,134	$48.14	$39.07	226
Colorado	5,308	$52.46	$40.47	118
Kansas	5,197	$46.75	$38.31	155
Wisconsin	5,155	$48.70	$38.42	214
Arkansas	4,639	$47.51	$40.15	195
Missouri	4,578	$50.23	$40.21	183
New Hampshire	3,633	$53.22	$39.89	129
Utah	3,369	$48.45	$38.42	115
Delaware	2,228	$51.69	$39.70	96
Iowa	2,029	$48.43	$39.47	106
West Virginia	1,650	$48.92	$40.05	66
Idaho	1,558	$48.17	$39.19	72
Vermont	1,199	$51.24	$38.87	53
Nebraska	1,180	$49.06	$38.96	57
Oregon	1,139	$50.92	$38.36	43
Maine	1,104	$49.76	$40.06	28
New Mexico	1,021	$48.53	$38.64	33
Rhode Island	982	$54.51	$39.79	34
North Dakota	606	$50.81	$39.34	33
District of Columbia	584	$58.31	$40.23	20
South Dakota	494	$51.40	$40.28	31
Montana	383	$52.30	$40.63	16
Alaska	236	$56.81	$36.51	8
Wyoming	120	$52.19	$38.50	5
Hawaii	85	$57.35	$39.01	4
Guam	54	$54.98	$40.80	3
XX	45	$58.57	$41.85	1
ZZ	42	$52.48	$42.02	1
AP	25	$48.47	$38.09	1

Related codes

G0103Prostate cancer screening; prostate specific antigen test (psa)$18.89
G0127Trimming of dystrophic nails$17.81
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.