How much does Medicare pay for HCPCS G0238?

Medicare allowed an average of $10.50 per service and paid $8.29 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $44.62, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Which specialty bills G0238 most?

Pulmonary Disease, with 57,317 services from 7 clinicians. Next are Physical Therapist in Private Practice, Internal Medicine, Clinical Cardiac Electrophysiology.

HCPCS G0238

Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring)

$10.50Medicare-allowed amount per service, averaged across 73,069 services

Providers submitted

$44.62

Asking price, not received

Medicare allowed

$10.50

The fee schedule figure

Medicare paid

$8.29

Balance is patient coinsurance

Providers submitted an average of $44.62 for this code and Medicare allowed $10.50 — 4.2× 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 $8.29 (79%); the rest is the patient’s coinsurance and deductible.

Services: 73,069
Beneficiaries: 714
Providers billing it: 18
Total allowed: $767,225

What Medicare pays for HCPCS G0238

Across 73,069 services billed by 18 providers to 714 beneficiaries, Medicare allowed an average of $10.50 per service. That is 102.3 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 G0238

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pulmonary Disease	57,317	434	$10.61	7
Physical Therapist in Private Practice	8,741	80	$10.08	3
Internal Medicine	4,876	90	$12.00	3
Clinical Cardiac Electrophysiology	1,304	23	$2.96	1
Neurology	602	15	$10.63	1
Physical Medicine and Rehabilitation	172	43	$11.53	1
Family Practice	43	15	$9.28	1
Gastroenterology	14	14	$12.42	1

G0238 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
Illinois	55,462	$10.61	$8.03	1
Nevada	8,076	$10.08	$8.03	2
New Jersey	3,222	$11.81	$7.94	1
New York	2,505	$11.70	$7.97	5
New Mexico	1,304	$2.96	$8.09	1
California	788	$11.07	$7.88	1
Washington	602	$10.63	$7.96	1
Michigan	455	$9.74	$7.60	1
Texas	454	$9.98	$7.72	1
Arizona	158	$9.82	$3.95	3
Ohio	43	$9.28	$7.91	1

Related codes

G0283Electrical stimulation (unattended)$8.75
G0279Diagnostic digital breast tomosynthesis$33.24
G0249Provision of test materials and equipment for home inr monitoring of p$87.99
G0268Removal of impacted cerumen (one or both ears) by physician on same da$49.73
G0277Hyperbaric oxygen under pressure$182.01
G0260Injection procedure for sacroiliac joint; provision of anesthetic$292.85
G0270Medical nutrition therapy; reassessment and subsequent intervention(s)$26.66
G0250Physician review$8.26
G0296Counseling visit to discuss need for lung cancer screening$24.73
G0237Therapeutic procedures to increase strength or endurance of respirator$12.17
G0239Therapeutic procedures to improve respiratory function or increase str$13.67
G0247Routine foot care by a physician of a diabetic patient$67.85

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.