How much does Medicare pay for HCPCS G0402?

Medicare allowed an average of $158.02 per service and paid $158.02 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $346.65, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does G0402 pay differently in an office than a hospital?

Yes. The allowed amount averaged $158.46 in an office setting and $124.14 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 G0402 most?

Family Practice, with 105,709 services from 6,574 clinicians. Next are Internal Medicine, Nurse Practitioner, Physician Assistant.

HCPCS G0402

Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment

$158.02Medicare-allowed amount per service, averaged across 217,525 services

Providers submitted

$346.65

Asking price, not received

Medicare allowed

$158.02

The fee schedule figure

Medicare paid

$158.02

Balance is patient coinsurance

Providers submitted an average of $346.65 for this code and Medicare allowed $158.02 — 2.2× 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 $158.02 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $158.46
Hospital / facility: $124.14

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. 214,755 services were billed in an office setting and 2,770 in a facility.

Services: 217,525
Beneficiaries: 217,522
Providers billing it: 13,481
Total allowed: $34,373,301

What Medicare pays for HCPCS G0402

Across 217,525 services billed by 13,481 providers to 217,522 beneficiaries, Medicare allowed an average of $158.02 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 G0402

Specialty	Services	Beneficiaries	Avg allowed	Providers
Family Practice	105,709	105,708	$157.86	6,574
Internal Medicine	90,793	90,791	$162.34	5,515
Nurse Practitioner	11,956	11,956	$133.08	813
Physician Assistant	4,710	4,710	$134.76	318
General Practice	1,491	1,491	$162.68	86
Geriatric Medicine	442	442	$158.81	25
Hospitalist	410	410	$162.74	27
Pediatric Medicine	409	409	$160.66	27
Emergency Medicine	366	366	$161.51	22
Cardiology	232	232	$183.96	13
Obstetrics & Gynecology	227	227	$167.78	11
Nephrology	160	160	$180.02	10
Osteopathic Manipulative Medicine	158	158	$170.97	9
Pulmonary Disease	135	135	$175.31	9
Infectious Disease	69	69	$178.87	5

G0402 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
Florida	18,128	$157.94	$158.42	1,059
Texas	16,912	$156.50	$159.04	1,014
Illinois	13,601	$163.74	$157.44	835
Pennsylvania	12,273	$156.34	$159.61	777
California	11,973	$173.44	$159.65	695
New Jersey	11,742	$171.95	$161.09	683
New York	10,770	$180.18	$160.49	650
Virginia	10,581	$156.44	$156.07	644
Maryland	8,423	$166.97	$158.65	492
Georgia	7,894	$156.60	$160.93	464
Ohio	7,408	$145.52	$157.02	514
Massachusetts	6,579	$167.68	$159.42	427
North Carolina	6,450	$151.14	$159.02	424
South Carolina	6,424	$153.19	$158.83	385
Tennessee	6,286	$146.05	$156.04	388
Indiana	5,403	$151.78	$159.67	346
Arizona	4,292	$155.72	$158.23	272
Michigan	4,202	$153.30	$158.89	277
Iowa	3,900	$145.47	$155.56	250
Wisconsin	3,880	$147.38	$155.63	275
Missouri	3,679	$146.48	$155.12	235
Kansas	3,513	$142.89	$155.93	212
Colorado	3,200	$155.79	$160.16	206
Kentucky	3,021	$149.66	$157.97	201
Nebraska	2,671	$142.35	$157.13	168
Oklahoma	2,647	$145.94	$158.24	172
Louisiana	2,638	$151.00	$159.88	161
Delaware	2,455	$155.61	$157.50	126
Arkansas	2,021	$142.08	$160.80	136
Alabama	1,472	$148.37	$160.69	103
Mississippi	1,390	$146.69	$156.94	83
Minnesota	1,233	$152.76	$156.17	95
New Hampshire	1,206	$150.95	$149.46	81
Connecticut	1,162	$173.97	$160.34	84
Washington	1,126	$165.54	$157.68	83
Nevada	770	$158.12	$160.75	48
Utah	695	$154.38	$159.41	46
Oregon	677	$157.73	$159.64	47
West Virginia	675	$137.22	$142.60	46
New Mexico	670	$150.65	$157.10	45
Montana	668	$147.88	$151.96	42
South Dakota	499	$141.78	$146.66	32
Wyoming	496	$151.00	$156.22	32
Idaho	370	$143.52	$150.35	30
North Dakota	305	$120.35	$125.34	17
Vermont	298	$143.50	$146.12	23
District of Columbia	271	$177.19	$159.29	17
Rhode Island	235	$156.56	$158.75	15
Maine	123	$143.47	$150.64	10
Alaska	101	$198.97	$155.43	6
Hawaii	73	$163.43	$161.66	5
Guam	31	$155.02	$151.59	2
XX	13	$162.21	$162.05	1

Related codes

G0439Annual wellness visit$117.95
G0444Annual depression screening$17.80
G0471Collection of venous blood by venipuncture or urine sample by catheter$10.56
G0442Annual alcohol misuse screening$17.96
G0480Drug test(s), definitive, utilizing (1) drug identification methods ab$110.33
G0483Drug test(s), definitive, utilizing (1) drug identification methods ab$240.71
G0482Drug test(s), definitive, utilizing (1) drug identification methods ab$193.45
G0481Drug test(s), definitive, utilizing (1) drug identification methods ab$152.51
G0438Annual wellness visit; includes a personalized prevention plan of serv$151.05
G0453Continuous intraoperative neurophysiology monitoring$32.00
G0446Annual, face-to-face intensive behavioral therapy for cardiovascular d$24.56
G0447Face-to-face behavioral counseling for obesity$24.83

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.