How much does Medicare pay for HCPCS G0250?

Medicare allowed an average of $8.26 per service and paid $6.08 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $26.87, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does G0250 pay differently in an office than a hospital?

Yes. The allowed amount averaged $8.32 in an office setting and $7.60 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 G0250 most?

Cardiology, with 18,747 services from 184 clinicians. Next are Interventional Cardiology, Nurse Practitioner, Clinical Cardiac Electrophysiology.

HCPCS G0250

Physician review, interpretation, and patient management of home inr testing for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; testing not occurring more frequent

$8.26Medicare-allowed amount per service, averaged across 40,709 services

Providers submitted

$26.87

Asking price, not received

Medicare allowed

$8.26

The fee schedule figure

Medicare paid

$6.08

Balance is patient coinsurance

Providers submitted an average of $26.87 for this code and Medicare allowed $8.26 — 3.3× 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 $6.08 (74%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $8.32
Hospital / facility: $7.60

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. 37,386 services were billed in an office setting and 3,323 in a facility.

Services: 40,709
Beneficiaries: 11,644
Providers billing it: 376
Total allowed: $336,256

What Medicare pays for HCPCS G0250

Across 40,709 services billed by 376 providers to 11,644 beneficiaries, Medicare allowed an average of $8.26 per service. That is 3.5 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 G0250

Specialty	Services	Beneficiaries	Avg allowed	Providers
Cardiology	18,747	5,569	$8.62	184
Interventional Cardiology	7,748	1,538	$8.31	68
Nurse Practitioner	6,847	2,529	$7.14	42
Clinical Cardiac Electrophysiology	3,057	585	$8.46	29
Internal Medicine	2,057	651	$8.60	22
Physician Assistant	922	376	$7.37	10
Family Practice	626	146	$8.30	11
Advanced Heart Failure and Transplant Cardiology	441	166	$8.77	7
Emergency Medicine	203	24	$8.54	1
Sleep Medicine	36	35	$8.08	1
Thoracic Surgery	25	25	$8.96	1

G0250 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
Iowa	6,894	$7.83	$5.98	36
Illinois	3,415	$8.54	$6.27	47
Michigan	2,370	$8.69	$6.17	25
Wisconsin	2,151	$8.06	$6.07	16
Florida	2,132	$8.51	$6.29	32
Pennsylvania	1,970	$8.47	$6.42	26
New Jersey	1,845	$9.47	$6.52	18
Missouri	1,531	$7.32	$5.18	15
Kansas	1,479	$7.21	$5.46	7
Mississippi	1,457	$8.43	$6.12	12
Georgia	1,320	$8.45	$6.45	13
Louisiana	1,309	$8.21	$5.98	12
California	1,189	$8.76	$5.84	10
Texas	1,171	$8.52	$6.28	7
Tennessee	1,167	$8.26	$6.18	12
Kentucky	999	$7.42	$5.29	5
West Virginia	983	$8.56	$6.29	12
New York	904	$9.19	$6.24	11
Arizona	794	$8.46	$6.11	10
Virginia	661	$8.54	$6.30	6
Delaware	648	$8.51	$6.49	6
Utah	635	$7.60	$5.79	6
Massachusetts	633	$8.56	$6.40	3
Indiana	564	$7.16	$4.86	3
Maryland	493	$8.90	$6.13	3
Alabama	433	$7.34	$5.81	5
Nebraska	209	$8.10	$6.34	1
Minnesota	207	$7.70	$5.59	3
South Carolina	197	$7.16	$5.22	2
New Mexico	196	$8.45	$6.34	2
Nevada	162	$8.53	$6.43	2
North Carolina	128	$8.22	$6.11	1
Alaska	121	$11.57	$5.87	2
Ohio	120	$8.38	$5.68	2
Vermont	84	$8.31	$6.60	1
Wyoming	73	$8.95	$6.50	1
Oklahoma	65	$8.21	$6.37	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
G0238Therapeutic procedures to improve respiratory function$10.50
G0270Medical nutrition therapy; reassessment and subsequent intervention(s)$26.66
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.