How much does Medicare pay for HCPCS G0397?

Medicare allowed an average of $67.11 per service and paid $51.46 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $221.56, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Which specialty bills G0397 most?

Family Practice, with 509 services from 4 clinicians. Next are Physical Medicine and Rehabilitation, Pain Management, Psychiatry.

HCPCS G0397

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

$67.11Medicare-allowed amount per service, averaged across 1,836 services

Providers submitted

$221.56

Asking price, not received

Medicare allowed

$67.11

The fee schedule figure

Medicare paid

$51.46

Balance is patient coinsurance

Providers submitted an average of $221.56 for this code and Medicare allowed $67.11 — 3.3× 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 $51.46 (77%); the rest is the patient’s coinsurance and deductible.

Services: 1,836
Beneficiaries: 915
Providers billing it: 22
Total allowed: $123,214

What Medicare pays for HCPCS G0397

Across 1,836 services billed by 22 providers to 915 beneficiaries, Medicare allowed an average of $67.11 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 G0397

Specialty	Services	Beneficiaries	Avg allowed	Providers
Family Practice	509	239	$74.17	4
Physical Medicine and Rehabilitation	367	194	$67.96	3
Pain Management	278	130	$65.55	1
Psychiatry	243	66	$71.60	2
Internal Medicine	168	161	$57.24	5
Licensed Clinical Social Worker	117	27	$50.71	2
Nurse Practitioner	97	70	$57.45	3
Oral Surgery (Dentist only)	40	11	$63.08	1
General Practice	17	17	$73.84	1

G0397 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
New York	607	$73.88	$51.06	4
California	332	$69.93	$48.49	4
New Hampshire	278	$65.55	$52.04	1
New Jersey	255	$61.03	$46.65	4
Texas	116	$63.88	$50.00	2
Connecticut	101	$51.57	$39.01	1
Minnesota	56	$58.01	$45.11	2
Arizona	42	$54.70	$41.17	1
Maryland	29	$70.59	$39.11	2
Florida	20	$58.03	$44.22	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
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

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.