How much does Medicare pay for HCPCS G0403?

Medicare allowed an average of $14.18 per service and paid $6.88 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $50.97, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Which specialty bills G0403 most?

Internal Medicine, with 15,996 services from 948 clinicians. Next are Family Practice, Nurse Practitioner, Cardiology.

HCPCS G0403

Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report

$14.18Medicare-allowed amount per service, averaged across 35,999 services

Providers submitted

$50.97

Asking price, not received

Medicare allowed

$14.18

The fee schedule figure

Medicare paid

$6.88

Balance is patient coinsurance

Providers submitted an average of $50.97 for this code and Medicare allowed $14.18 — 3.6× 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 $6.88 (49%); the rest is the patient’s coinsurance and deductible.

Services: 35,999
Beneficiaries: 35,999
Providers billing it: 2,177
Total allowed: $510,466

What Medicare pays for HCPCS G0403

Across 35,999 services billed by 2,177 providers to 35,999 beneficiaries, Medicare allowed an average of $14.18 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 G0403

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	15,996	15,996	$14.56	948
Family Practice	15,677	15,677	$14.07	984
Nurse Practitioner	2,126	2,126	$12.06	122
Cardiology	751	751	$15.69	38
Physician Assistant	690	690	$11.81	44
General Practice	129	129	$14.41	7
Clinical Cardiac Electrophysiology	128	128	$16.32	4
Pediatric Medicine	125	125	$14.11	9
Hospice and Palliative Care	73	73	$16.55	1
Geriatric Medicine	68	68	$14.15	4
Nephrology	37	37	$16.00	3
Osteopathic Manipulative Medicine	33	33	$15.01	2
Hospitalist	27	27	$14.21	2
Interventional Cardiology	25	25	$15.76	1
Emergency Medicine	24	24	$13.65	2

G0403 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	4,561	$13.93	$7.07	259
New Jersey	3,359	$15.69	$7.69	162
North Carolina	2,481	$13.26	$6.76	163
New York	2,142	$16.34	$7.76	125
Texas	2,070	$13.73	$6.56	133
Georgia	1,982	$13.79	$6.79	116
Pennsylvania	1,868	$14.02	$6.24	123
California	1,814	$15.21	$7.36	92
Maryland	1,770	$14.94	$6.80	101
South Carolina	1,621	$13.15	$7.17	95
Virginia	1,589	$14.06	$6.59	97
Tennessee	1,350	$12.50	$6.51	83
Ohio	1,276	$13.42	$6.01	93
Illinois	1,164	$14.85	$6.40	79
Arizona	920	$13.64	$6.60	59
Michigan	644	$14.32	$6.02	45
Colorado	548	$14.36	$6.63	34
Massachusetts	547	$15.09	$7.45	37
Nebraska	469	$12.91	$6.25	32
Kansas	450	$13.08	$6.25	29
Indiana	379	$13.05	$5.85	23
Delaware	365	$13.70	$6.42	22
Missouri	283	$13.54	$6.23	20
Iowa	236	$12.93	$6.48	15
Connecticut	216	$15.35	$7.29	17
Arkansas	203	$12.68	$6.99	15
Alabama	200	$12.83	$7.63	14
Louisiana	175	$13.25	$6.38	10
Kentucky	173	$12.96	$6.90	11
Wisconsin	160	$13.52	$5.32	13
Washington	159	$14.81	$5.41	10
New Hampshire	118	$14.37	$6.75	7
Oklahoma	102	$13.10	$5.51	7
Mississippi	86	$12.77	$8.88	6
Nevada	82	$12.75	$8.10	3
South Dakota	72	$13.57	$5.73	4
District of Columbia	55	$16.25	$7.54	3
Montana	54	$14.18	$6.02	4
Oregon	54	$13.83	$4.70	4
New Mexico	53	$13.65	$6.05	3
Utah	39	$13.65	$6.29	2
West Virginia	32	$13.32	$5.71	2
Idaho	31	$11.12	$5.07	2
Hawaii	24	$13.32	$9.30	1
Rhode Island	12	$15.03	$6.53	1
Maine	11	$14.50	$7.18	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.