How much does Medicare pay for HCPCS G0296?

Medicare allowed an average of $24.73 per service and paid $24.73 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $99.16, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does G0296 pay differently in an office than a hospital?

Yes. The allowed amount averaged $25.52 in an office setting and $20.89 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 G0296 most?

Nurse Practitioner, with 12,763 services from 275 clinicians. Next are Pulmonary Disease, Family Practice, Internal Medicine.

HCPCS G0296

Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making)

$24.73Medicare-allowed amount per service, averaged across 35,475 services

Providers submitted

$99.16

Asking price, not received

Medicare allowed

$24.73

The fee schedule figure

Medicare paid

$24.73

Balance is patient coinsurance

Providers submitted an average of $99.16 for this code and Medicare allowed $24.73 — 4.0× 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 $24.73 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $25.52
Hospital / facility: $20.89

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. 29,445 services were billed in an office setting and 6,030 in a facility.

Services: 35,475
Beneficiaries: 33,671
Providers billing it: 1,192
Total allowed: $877,297

What Medicare pays for HCPCS G0296

Across 35,475 services billed by 1,192 providers to 33,671 beneficiaries, Medicare allowed an average of $24.73 per service. 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 G0296

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	12,763	12,555	$22.22	275
Pulmonary Disease	8,981	7,977	$27.09	271
Family Practice	5,336	5,143	$26.37	293
Internal Medicine	4,380	4,188	$27.02	217
Physician Assistant	2,252	2,175	$22.03	80
Critical Care (Intensivists)	666	595	$27.53	28
Diagnostic Radiology	618	617	$18.13	7
General Practice	134	116	$26.12	4
Certified Clinical Nurse Specialist	96	93	$21.20	2
Interventional Cardiology	51	41	$26.72	3
Medical Oncology	40	18	$24.58	1
Hospitalist	32	32	$26.73	2
Thoracic Surgery	29	29	$32.48	2
Cardiology	19	18	$25.65	1
Osteopathic Manipulative Medicine	17	15	$26.01	1

G0296 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
New York	4,004	$27.92	$25.41	123
Ohio	2,537	$22.84	$23.64	104
South Carolina	2,480	$23.71	$24.57	76
Florida	2,105	$26.02	$25.28	63
Pennsylvania	1,801	$24.67	$24.44	47
Virginia	1,574	$25.54	$25.34	77
Massachusetts	1,369	$26.43	$25.67	49
California	1,283	$20.63	$19.54	27
Arizona	1,158	$24.29	$24.62	44
North Carolina	1,147	$24.48	$25.57	52
Maryland	1,062	$27.06	$26.48	32
Tennessee	1,060	$22.85	$24.26	36
Georgia	1,033	$25.70	$26.18	39
Michigan	958	$23.13	$23.08	30
Delaware	880	$23.26	$23.27	5
Illinois	868	$25.25	$25.05	27
Indiana	825	$23.66	$24.63	31
Oklahoma	807	$22.78	$23.64	15
Wisconsin	791	$23.64	$24.06	20
New Jersey	736	$27.23	$25.53	22
Kansas	632	$22.95	$23.92	12
Kentucky	631	$25.09	$26.07	36
Mississippi	532	$23.96	$25.14	17
Texas	458	$25.26	$25.23	17
Guam	386	$27.72	$27.05	3
Washington	323	$25.30	$24.86	15
Maine	310	$21.69	$22.17	12
Missouri	309	$25.19	$25.86	15
Louisiana	288	$24.52	$25.65	12
Oregon	286	$22.36	$22.11	9
Colorado	263	$23.56	$22.63	12
South Dakota	241	$24.43	$24.95	13
Nevada	237	$24.01	$24.63	6
Arkansas	229	$22.23	$23.56	10
Montana	225	$21.61	$21.65	7
Minnesota	218	$24.14	$23.98	11
North Dakota	206	$20.88	$21.20	7
Alabama	203	$24.77	$26.50	13
Connecticut	191	$28.50	$26.58	9
New Hampshire	190	$26.12	$24.98	12
Nebraska	172	$21.77	$22.77	7
District of Columbia	151	$26.19	$23.57	2
West Virginia	114	$22.28	$22.61	4
Iowa	84	$24.69	$26.24	5
Alaska	47	$29.29	$22.38	3
Vermont	38	$29.98	$26.97	1
Utah	22	$24.44	$24.98	2
Rhode Island	11	$27.58	$26.96	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
G0250Physician review$8.26
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.