How much does Medicare pay for HCPCS G0406?

Medicare allowed an average of $39.14 per service and paid $30.45 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $113.67, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does G0406 pay differently in an office than a hospital?

Yes. The allowed amount averaged $39.08 in an office setting and $39.57 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 G0406 most?

Neurology, with 1,877 services from 36 clinicians. Next are Nurse Practitioner, Psychiatry, Family Practice.

HCPCS G0406

Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth

$39.14Medicare-allowed amount per service, averaged across 6,741 services

Providers submitted

$113.67

Asking price, not received

Medicare allowed

$39.14

The fee schedule figure

Medicare paid

$30.45

Balance is patient coinsurance

Providers submitted an average of $113.67 for this code and Medicare allowed $39.14 — 2.9× 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 $30.45 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $39.08
Hospital / facility: $39.57

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 5,826 services were billed in an office setting and 915 in a facility.

Services: 6,741
Beneficiaries: 3,705
Providers billing it: 108
Total allowed: $263,843

What Medicare pays for HCPCS G0406

Across 6,741 services billed by 108 providers to 3,705 beneficiaries, Medicare allowed an average of $39.14 per service. That is 1.8 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 G0406

Specialty	Services	Beneficiaries	Avg allowed	Providers
Neurology	1,877	1,266	$40.59	36
Nurse Practitioner	1,402	717	$32.69	23
Psychiatry	920	468	$39.44	17
Family Practice	713	133	$43.52	3
Nephrology	458	161	$38.57	3
Geriatric Medicine	452	338	$43.73	1
Internal Medicine	364	204	$41.06	8
Infectious Disease	245	181	$38.22	5
Hospitalist	72	66	$39.14	1
Pulmonary Disease	45	24	$40.64	2
Dermatology	35	25	$42.20	1
Anesthesiology	35	23	$49.72	1
Cardiology	34	28	$39.21	2
Critical Care (Intensivists)	23	23	$38.85	1
Pain Management	21	12	$39.20	1

G0406 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	1,163	$39.83	$31.14	22
New Jersey	835	$43.16	$31.33	6
Illinois	708	$42.79	$31.75	5
Arkansas	565	$31.56	$27.02	3
Pennsylvania	458	$39.02	$31.74	8
Utah	378	$38.38	$31.85	1
New York	343	$42.12	$31.06	4
Texas	336	$37.61	$30.11	11
Georgia	288	$38.90	$31.85	3
California	283	$42.43	$26.33	4
Kentucky	223	$32.54	$25.38	2
Louisiana	184	$36.53	$30.37	2
Tennessee	118	$35.98	$28.45	3
Oklahoma	97	$35.41	$29.62	3
Michigan	86	$35.98	$29.72	4
Nevada	75	$34.08	$20.98	2
Virginia	75	$40.57	$30.75	3
Missouri	65	$38.50	$31.18	2
Washington	64	$43.06	$29.87	4
North Carolina	59	$38.75	$32.00	3
Montana	48	$33.28	$26.42	1
Puerto Rico	45	$37.74	$31.37	1
West Virginia	45	$39.57	$31.40	1
Colorado	40	$37.16	$28.45	2
Indiana	30	$42.70	$32.10	1
Alaska	23	$37.79	$32.10	1
South Carolina	23	$38.85	$32.01	1
Ohio	21	$39.28	$32.11	1
Arizona	19	$33.58	$27.27	1
Nebraska	18	$40.31	$32.10	1
Connecticut	15	$40.25	$32.00	1
Alabama	11	$37.77	$32.05	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.