How much does Medicare pay for HCPCS G0316?

Medicare allowed an average of $28.58 per service and paid $22.76 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $113.06, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Which specialty bills G0316 most?

Internal Medicine, with 102,930 services from 1,180 clinicians. Next are Nurse Practitioner, Hospitalist, Physician Assistant.

HCPCS G0316

Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by th

$28.58Medicare-allowed amount per service, averaged across 399,984 services

Providers submitted

$113.06

Asking price, not received

Medicare allowed

$28.58

The fee schedule figure

Medicare paid

$22.76

Balance is patient coinsurance

Providers submitted an average of $113.06 for this code and Medicare allowed $28.58 — 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 $22.76 (80%); the rest is the patient’s coinsurance and deductible.

Services: 399,984
Beneficiaries: 165,025
Providers billing it: 5,098
Total allowed: $11,431,543

What Medicare pays for HCPCS G0316

Across 399,984 services billed by 5,098 providers to 165,025 beneficiaries, Medicare allowed an average of $28.58 per service. That is 2.4 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 G0316

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	102,930	38,384	$30.24	1,180
Nurse Practitioner	85,872	36,116	$25.19	1,099
Hospitalist	57,569	26,632	$30.64	859
Physician Assistant	41,530	16,654	$25.03	575
Hospice and Palliative Care	23,483	9,549	$30.04	290
Neurology	12,424	4,472	$30.20	101
Family Practice	12,382	5,329	$29.65	165
Infectious Disease	10,619	6,006	$30.06	136
Physical Medicine and Rehabilitation	9,003	4,498	$30.03	75
Hematology-Oncology	8,589	1,866	$29.24	80
Pulmonary Disease	5,428	2,248	$30.25	62
Psychiatry	4,862	1,727	$30.11	79
Geriatric Medicine	4,595	2,158	$29.88	63
Cardiology	3,916	2,015	$29.91	70
Neurosurgery	1,602	493	$30.36	16

G0316 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	59,682	$31.03	$23.02	540
Pennsylvania	27,538	$27.73	$22.15	311
Illinois	26,674	$29.71	$22.34	348
Texas	25,534	$28.76	$22.75	208
Georgia	24,663	$27.86	$21.95	128
Florida	18,486	$27.87	$21.89	216
Maryland	17,770	$29.52	$22.39	237
Michigan	14,670	$27.56	$21.47	260
New York	14,326	$28.99	$21.91	190
Utah	12,959	$26.89	$21.88	133
Wisconsin	12,453	$25.55	$21.02	199
Oregon	12,241	$29.06	$22.68	224
Minnesota	12,171	$27.14	$22.08	244
Massachusetts	10,513	$29.89	$22.35	153
Washington	9,110	$29.70	$22.72	155
North Carolina	8,616	$25.70	$21.32	106
Missouri	7,836	$28.09	$22.49	122
Colorado	7,820	$27.94	$21.94	140
Arizona	7,177	$27.28	$21.96	128
Virginia	7,165	$29.56	$22.40	91
Indiana	4,962	$26.01	$21.62	81
Tennessee	4,376	$27.18	$22.28	88
Nevada	4,014	$28.63	$22.59	41
South Carolina	4,002	$26.26	$21.17	51
Maine	4,000	$27.55	$21.80	70
Kansas	3,052	$27.92	$22.80	57
Ohio	3,036	$28.26	$22.44	57
Louisiana	2,614	$25.92	$20.88	19
Alabama	2,405	$27.80	$23.05	21
New Jersey	2,356	$30.49	$22.55	46
Hawaii	2,350	$30.58	$23.25	15
New Hampshire	2,209	$28.57	$22.37	41
Kentucky	2,158	$27.97	$22.32	36
Iowa	2,143	$27.91	$22.86	37
South Dakota	2,127	$26.66	$21.76	22
District of Columbia	1,987	$32.43	$23.04	42
Idaho	1,921	$25.90	$21.56	28
Rhode Island	1,880	$25.81	$20.19	8
Connecticut	1,848	$29.12	$21.77	41
Montana	1,510	$28.11	$22.16	35
Arkansas	1,443	$26.70	$22.63	14
Vermont	1,368	$28.29	$22.76	12
Delaware	1,075	$28.50	$22.62	28
Nebraska	993	$26.22	$21.83	16
New Mexico	908	$27.09	$21.28	15
Oklahoma	690	$27.53	$22.30	15
West Virginia	346	$26.98	$21.04	12
North Dakota	343	$28.56	$22.94	6
Wyoming	235	$24.80	$19.98	5
Alaska	165	$36.46	$21.81	4
Mississippi	64	$27.53	$23.54	2

Related codes

G0328Colorectal cancer screening; fecal occult blood test$17.64
G0318Prolonged home or residence evaluation and management service(s) beyon$27.69
G0317Prolonged nursing facility evaluation and management service(s) beyond$27.01
G0399Home sleep test (hst)$67.71
G0396Alcohol and/or substance (other than tobacco) misuse structured assess$32.81
G0306Complete cbc, automated (hgb, hct, rbc, wbc, without platelet count) a$7.60
G0307Complete (cbc)$6.33
G0340Image-guided robotic linear accelerator-based stereotactic radiosurger$2145.82
G0323Care management services for behavioral health conditions$43.42
G0398Home sleep study test (hst)$127.41
G0339Image-guided robotic linear accelerator-based stereotactic radiosurger$2840.40
G0372Physician service required to establish and document the need for a po$7.68

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.