How much does Medicare pay for HCPCS G0181?

Medicare allowed an average of $103.01 per service and paid $79.93 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $164.83, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does G0181 pay differently in an office than a hospital?

Yes. The allowed amount averaged $103.02 in an office setting and $102.13 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 G0181 most?

Family Practice, with 117,768 services from 429 clinicians. Next are Internal Medicine, Nurse Practitioner, General Practice.

HCPCS G0181

Physician or allowed practitioner supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician or allow

$103.01Medicare-allowed amount per service, averaged across 435,933 services

Providers submitted

$164.83

Asking price, not received

Medicare allowed

$103.01

The fee schedule figure

Medicare paid

$79.93

Balance is patient coinsurance

Providers submitted an average of $164.83 for this code and Medicare allowed $103.01 — 1.6× 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 $79.93 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $103.02
Hospital / facility: $102.13

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. 433,916 services were billed in an office setting and 2,017 in a facility.

Services: 435,933
Beneficiaries: 130,192
Providers billing it: 1,943
Total allowed: $44,905,458

What Medicare pays for HCPCS G0181

Across 435,933 services billed by 1,943 providers to 130,192 beneficiaries, Medicare allowed an average of $103.01 per service. That is 3.3 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 G0181

Specialty	Services	Beneficiaries	Avg allowed	Providers
Family Practice	117,768	32,497	$106.28	429
Internal Medicine	102,945	33,764	$106.47	641
Nurse Practitioner	73,441	26,094	$86.16	553
General Practice	48,670	12,354	$107.08	64
Emergency Medicine	41,229	10,200	$110.07	29
Pathology	8,987	2,075	$110.10	3
Preventive Medicine	8,583	1,718	$104.19	2
Physician Assistant	7,908	2,902	$86.45	54
General Surgery	6,503	1,610	$104.08	4
Cardiology	4,391	788	$105.48	20
Nephrology	2,739	906	$107.36	7
Physical Medicine and Rehabilitation	2,625	835	$110.15	6
Neurology	2,257	567	$103.03	5
Infectious Disease	1,878	1,215	$104.11	51
Gastroenterology	1,407	534	$108.41	5

G0181 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	236,386	$108.36	$80.05	388
Texas	62,525	$94.15	$73.60	349
Illinois	37,986	$103.76	$77.97	164
Florida	20,788	$94.80	$72.70	214
Nevada	17,762	$91.63	$74.14	59
Arizona	7,168	$92.20	$73.64	67
Georgia	5,325	$109.07	$80.91	14
New York	4,881	$107.88	$79.11	68
Utah	3,981	$87.30	$68.94	29
Indiana	3,573	$88.59	$72.84	33
Oklahoma	3,384	$92.17	$74.27	57
Connecticut	3,277	$108.18	$80.37	8
Michigan	3,038	$102.30	$77.36	53
Tennessee	2,994	$87.75	$72.38	42
Pennsylvania	2,501	$102.77	$77.74	24
Massachusetts	2,491	$103.23	$78.34	58
New Jersey	2,075	$106.19	$76.15	47
Mississippi	1,901	$82.95	$70.28	23
Louisiana	1,777	$93.22	$76.28	27
Ohio	1,553	$89.44	$70.76	34
North Carolina	1,320	$90.81	$73.99	10
Alabama	1,270	$92.82	$77.20	21
Washington	1,184	$99.40	$74.50	13
Arkansas	990	$95.43	$77.25	13
Maryland	951	$97.57	$70.55	22
Kansas	775	$95.72	$77.26	11
South Carolina	722	$87.72	$71.94	18
Colorado	722	$92.86	$73.89	9
Virginia	647	$93.52	$72.03	17
New Mexico	305	$95.93	$75.09	6
Oregon	295	$96.59	$73.58	7
Idaho	235	$81.21	$68.86	5
Kentucky	185	$90.22	$78.91	6
Missouri	168	$89.29	$77.39	4
Delaware	156	$102.55	$80.37	3
Wisconsin	152	$90.16	$73.55	6
Rhode Island	118	$105.07	$80.45	2
Guam	88	$106.89	$75.84	2
West Virginia	75	$96.09	$80.86	2
Hawaii	71	$111.27	$80.36	3
South Dakota	62	$99.89	$72.55	1
Vermont	24	$100.59	$81.89	1
New Hampshire	20	$103.47	$81.61	1
Alaska	18	$82.01	$69.52	1
District of Columbia	14	$102.96	$68.92	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
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.