How much does Medicare pay for HCPCS G0318?

Medicare allowed an average of $27.69 per service and paid $21.63 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $66.33, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does G0318 pay differently in an office than a hospital?

Yes. The allowed amount averaged $27.69 in an office setting and $24.41 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 G0318 most?

Nurse Practitioner, with 87,126 services from 675 clinicians. Next are Internal Medicine, Family Practice, Emergency Medicine.

HCPCS G0318

Prolonged home or residence 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 the physician or qualif

$27.69Medicare-allowed amount per service, averaged across 137,269 services

Providers submitted

$66.33

Asking price, not received

Medicare allowed

$27.69

The fee schedule figure

Medicare paid

$21.63

Balance is patient coinsurance

Providers submitted an average of $66.33 for this code and Medicare allowed $27.69 — 2.4× 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 $21.63 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $27.69
Hospital / facility: $24.41

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. 137,217 services were billed in an office setting and 52 in a facility.

Services: 137,269
Beneficiaries: 41,052
Providers billing it: 881
Total allowed: $3,800,979

What Medicare pays for HCPCS G0318

Across 137,269 services billed by 881 providers to 41,052 beneficiaries, Medicare allowed an average of $27.69 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 G0318

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	87,126	25,074	$25.93	675
Internal Medicine	22,877	7,011	$30.98	64
Family Practice	6,812	2,617	$30.76	49
Emergency Medicine	5,192	1,457	$31.84	8
General Practice	4,356	2,329	$31.98	9
Physician Assistant	3,570	1,030	$26.26	34
Geriatric Medicine	1,739	655	$30.72	20
Osteopathic Manipulative Medicine	1,474	82	$30.51	2
Pulmonary Disease	1,337	26	$31.89	1
Nephrology	839	203	$32.01	1
Hospice and Palliative Care	823	287	$33.00	8
Certified Clinical Nurse Specialist	520	210	$25.27	5
Hematology-Oncology	410	16	$28.88	1
Medical Oncology	80	11	$30.50	1
Neurology	57	14	$28.69	1

G0318 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
Florida	29,873	$28.03	$21.43	101
California	26,514	$30.57	$22.87	68
Texas	21,277	$26.48	$20.90	108
Maryland	7,146	$27.45	$20.11	29
Louisiana	4,503	$24.89	$20.37	16
Illinois	3,717	$28.50	$21.63	40
Massachusetts	3,693	$27.47	$20.49	31
Virginia	3,330	$26.70	$20.82	28
Ohio	2,369	$26.66	$21.38	24
Arizona	2,238	$25.82	$20.26	38
Tennessee	2,108	$24.87	$20.68	25
Indiana	2,098	$24.68	$20.10	20
Minnesota	2,088	$25.96	$20.32	29
South Carolina	1,934	$26.09	$20.77	25
New York	1,899	$30.26	$22.39	20
Pennsylvania	1,873	$25.75	$20.44	20
Idaho	1,509	$30.94	$23.43	4
North Carolina	1,497	$25.20	$20.39	33
Mississippi	1,350	$24.29	$20.61	9
West Virginia	1,179	$27.99	$21.18	6
Alabama	1,176	$23.84	$19.78	11
Nevada	1,106	$27.42	$22.54	11
Georgia	1,072	$26.40	$20.59	12
Michigan	1,042	$26.35	$20.60	24
New Jersey	994	$27.66	$20.38	19
Wisconsin	959	$25.48	$20.13	21
Colorado	918	$26.17	$20.46	12
Oklahoma	911	$29.16	$24.11	2
Kansas	870	$26.84	$22.40	4
Utah	727	$25.27	$20.54	11
Arkansas	663	$24.12	$20.45	5
Missouri	582	$25.97	$20.82	8
Washington	538	$27.65	$20.50	12
Maine	464	$25.40	$19.88	6
Kentucky	447	$24.83	$19.85	4
Hawaii	413	$29.16	$22.05	6
New Hampshire	367	$25.76	$20.35	9
Connecticut	350	$31.45	$23.32	4
District of Columbia	343	$31.90	$20.96	5
Oregon	337	$26.43	$19.45	6
Nebraska	291	$24.30	$20.16	5
South Dakota	203	$24.75	$19.96	2
Rhode Island	124	$23.06	$21.15	3
Vermont	63	$29.54	$23.09	1
New Mexico	42	$29.77	$23.57	1
North Dakota	32	$25.00	$20.59	1
AP	23	$34.80	$24.27	1
Montana	17	$25.84	$19.39	1

Related codes

G0316Prolonged hospital inpatient or observation care evaluation and manage$28.58
G0328Colorectal cancer screening; fecal occult blood test$17.64
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.