How much does Medicare pay for HCPCS G0323?

Medicare allowed an average of $43.42 per service and paid $33.73 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $90.26, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does G0323 pay differently in an office than a hospital?

Yes. The allowed amount averaged $44.52 in an office setting and $31.60 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 G0323 most?

Licensed Clinical Social Worker, with 3,951 services from 17 clinicians. Next are Psychologist, Clinical, Family Practice, Nurse Practitioner.

HCPCS G0323

Care management services for behavioral health conditions, at least 20 minutes of clinical psychologist, clinical social worker, mental health counselor, or marriage and family therapist time, per calendar month. (these services include the following requi

$43.42Medicare-allowed amount per service, averaged across 6,534 services

Providers submitted

$90.26

Asking price, not received

Medicare allowed

$43.42

The fee schedule figure

Medicare paid

$33.73

Balance is patient coinsurance

Providers submitted an average of $90.26 for this code and Medicare allowed $43.42 — 2.1× 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 $33.73 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $44.52
Hospital / facility: $31.60

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. 5,978 services were billed in an office setting and 556 in a facility.

Services: 6,534
Beneficiaries: 2,888
Providers billing it: 31
Total allowed: $283,706

What Medicare pays for HCPCS G0323

Across 6,534 services billed by 31 providers to 2,888 beneficiaries, Medicare allowed an average of $43.42 per service. That is 2.3 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 G0323

Specialty	Services	Beneficiaries	Avg allowed	Providers
Licensed Clinical Social Worker	3,951	1,295	$38.04	17
Psychologist, Clinical	2,176	1,307	$52.50	5
Family Practice	131	79	$41.57	1
Nurse Practitioner	118	94	$45.62	5
Psychiatry	57	47	$53.54	1
Physical Medicine and Rehabilitation	55	21	$58.47	1
Physician Assistant	46	45	$46.09	1

G0323 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
Texas	1,749	$41.77	$34.48	3
Nevada	1,327	$53.65	$42.95	1
Georgia	891	$40.89	$31.26	3
Indiana	804	$37.05	$31.79	3
Louisiana	465	$38.57	$31.59	1
Florida	340	$44.78	$34.60	7
Illinois	281	$39.68	$30.84	4
Kansas	147	$38.07	$31.40	1
Michigan	131	$41.57	$31.14	1
Arizona	114	$54.98	$42.66	2
Massachusetts	101	$34.16	$24.82	1
Iowa	75	$38.39	$32.28	2
California	55	$58.47	$42.74	1
Utah	54	$39.07	$32.06	1

Related codes

G0316Prolonged hospital inpatient or observation care evaluation and manage$28.58
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
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.