How much does Medicare pay for HCPCS G0396?

Medicare allowed an average of $32.81 per service and paid $24.67 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $90.24, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code G0396?

Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes. It was billed 60,152 times to 29,894 Medicare beneficiaries by 419 providers in 2024.

Does G0396 pay differently in an office than a hospital?

Yes. The allowed amount averaged $32.82 in an office setting and $31.61 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 G0396 most?

Interventional Pain Management, with 11,980 services from 37 clinicians. Next are Anesthesiology, Nurse Practitioner, Physical Medicine and Rehabilitation.

HCPCS G0396

Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes

$32.81Medicare-allowed amount per service, averaged across 60,152 services

Providers submitted

$90.24

Asking price, not received

Medicare allowed

$32.81

The fee schedule figure

Medicare paid

$24.67

Balance is patient coinsurance

Providers submitted an average of $90.24 for this code and Medicare allowed $32.81 — 2.8× 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 $24.67 (75%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $32.82
Hospital / facility: $31.61

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. 59,733 services were billed in an office setting and 419 in a facility.

Services: 60,152
Beneficiaries: 29,894
Providers billing it: 419
Total allowed: $1,973,587

What Medicare pays for HCPCS G0396

Across 60,152 services billed by 419 providers to 29,894 beneficiaries, Medicare allowed an average of $32.81 per service. That is 2.0 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 G0396

Specialty	Services	Beneficiaries	Avg allowed	Providers
Interventional Pain Management	11,980	4,670	$33.69	37
Anesthesiology	8,977	4,472	$33.18	46
Nurse Practitioner	8,130	3,356	$28.71	71
Physical Medicine and Rehabilitation	7,355	2,382	$33.96	28
Pain Management	6,769	3,029	$33.19	38
Internal Medicine	5,561	4,584	$34.72	68
Family Practice	3,464	2,178	$34.64	41
Physician Assistant	2,916	1,730	$28.37	34
Emergency Medicine	910	508	$34.16	5
General Practice	850	414	$32.32	5
Cardiology	685	599	$34.75	8
Interventional Cardiology	503	483	$33.51	8
Neurosurgery	503	132	$37.71	1
Neurology	261	173	$31.81	3
Clinical Cardiac Electrophysiology	200	198	$33.36	2

G0396 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	13,820	$33.17	$25.72	87
California	9,244	$33.73	$24.36	39
Florida	7,666	$33.80	$26.15	51
Tennessee	5,957	$28.36	$22.27	28
Maryland	4,290	$33.20	$22.66	35
Washington	2,696	$34.29	$25.57	2
New York	2,237	$35.08	$23.42	24
Georgia	1,815	$32.08	$24.60	17
Arizona	1,290	$30.21	$23.73	16
Pennsylvania	1,278	$32.88	$26.69	10
Massachusetts	1,141	$33.21	$26.31	7
Nevada	1,004	$35.23	$24.96	3
North Carolina	940	$33.40	$25.49	7
Alabama	682	$31.94	$25.59	11
Illinois	664	$33.76	$22.76	7
Delaware	645	$29.26	$23.74	7
Oklahoma	593	$31.09	$25.63	5
South Carolina	535	$33.50	$26.68	5
Michigan	449	$31.73	$23.42	9
Missouri	444	$32.29	$24.89	4
Virginia	369	$37.91	$17.85	2
Colorado	340	$32.19	$23.84	3
New Jersey	329	$34.95	$24.33	6
Minnesota	322	$29.81	$22.24	14
Ohio	291	$29.54	$25.85	2
New Hampshire	276	$33.16	$25.77	3
Kentucky	252	$32.38	$24.93	4
Oregon	173	$27.81	$18.68	2
Utah	158	$35.62	$25.11	1
Indiana	152	$28.83	$21.51	4
New Mexico	36	$32.98	$26.84	1
District of Columbia	24	$36.87	$26.57	1
Arkansas	23	$31.41	$23.65	1
Louisiana	17	$30.33	$27.12	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
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.