How much does Medicare pay for HCPCS G0398?

Medicare allowed an average of $127.41 per service and paid $97.69 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $483.46, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Which specialty bills G0398 most?

Pulmonary Disease, with 2,921 services from 56 clinicians. Next are Sleep Medicine, Internal Medicine, Independent Diagnostic Testing Facility (IDTF).

HCPCS G0398

Home sleep study test (hst) with type ii portable monitor, unattended; minimum of 7 channels: eeg, eog, emg, ecg/heart rate, airflow, respiratory effort and oxygen saturation

$127.41Medicare-allowed amount per service, averaged across 5,884 services

Providers submitted

$483.46

Asking price, not received

Medicare allowed

$127.41

The fee schedule figure

Medicare paid

$97.69

Balance is patient coinsurance

Providers submitted an average of $483.46 for this code and Medicare allowed $127.41 — 3.8× 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 $97.69 (77%); the rest is the patient’s coinsurance and deductible.

Services: 5,884
Beneficiaries: 5,221
Providers billing it: 124
Total allowed: $749,680

What Medicare pays for HCPCS G0398

Across 5,884 services billed by 124 providers to 5,221 beneficiaries, Medicare allowed an average of $127.41 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.

Who bills G0398

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pulmonary Disease	2,921	2,444	$118.59	56
Sleep Medicine	1,118	1,064	$92.38	22
Internal Medicine	573	534	$143.77	10
Independent Diagnostic Testing Facility (IDTF)	536	491	$179.37	6
Neurology	377	338	$164.46	13
Family Practice	192	186	$153.67	10
Cardiology	63	63	$154.46	4
Psychiatry	54	51	$236.82	1
Critical Care (Intensivists)	38	38	$127.52	1
Nurse Practitioner	12	12	$218.02	1

G0398 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
North Carolina	1,082	$49.82	$36.85	32
Florida	860	$128.98	$97.83	7
Texas	741	$129.06	$100.11	13
California	575	$181.44	$139.60	8
Ohio	552	$258.37	$198.04	8
New Jersey	423	$67.53	$51.94	5
New York	369	$110.92	$84.10	15
Indiana	207	$40.08	$29.65	5
Virginia	176	$139.50	$112.27	2
Pennsylvania	166	$125.19	$94.47	6
Illinois	109	$201.76	$144.56	2
Utah	88	$120.03	$86.48	1
Arizona	77	$159.59	$128.80	3
South Carolina	74	$132.62	$103.06	2
Wisconsin	54	$236.82	$203.22	1
Arkansas	47	$42.47	$32.94	2
Michigan	46	$126.39	$99.98	1
Nevada	46	$168.22	$129.88	1
New Hampshire	36	$314.70	$246.16	3
Nebraska	34	$39.81	$28.98	1
Wyoming	27	$167.46	$116.25	1
Georgia	27	$127.30	$93.87	1
Massachusetts	25	$375.04	$298.81	1
Maryland	17	$136.82	$102.81	1
Washington	15	$171.50	$134.49	1
New Mexico	11	$113.51	$97.60	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
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.