HCPCS G0328

Across 286,242 services billed by 1,926 providers to 286,241 beneficiaries, Medicare allowed an average of $17.64 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.

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.

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

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.

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