How much does Medicare pay for HCPCS G0407?

Medicare allowed an average of $63.68 per service and paid $50.11 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $178.47, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does G0407 pay differently in an office than a hospital?

Yes. The allowed amount averaged $62.85 in an office setting and $68.66 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 G0407 most?

Nurse Practitioner, with 10,052 services from 57 clinicians. Next are Neurology, Psychiatry, Infectious Disease.

HCPCS G0407

Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth

$63.68Medicare-allowed amount per service, averaged across 22,185 services

Providers submitted

$178.47

Asking price, not received

Medicare allowed

$63.68

The fee schedule figure

Medicare paid

$50.11

Balance is patient coinsurance

Providers submitted an average of $178.47 for this code and Medicare allowed $63.68 — 2.8× 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 $50.11 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $62.85
Hospital / facility: $68.66

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 19,017 services were billed in an office setting and 3,168 in a facility.

Services: 22,185
Beneficiaries: 10,370
Providers billing it: 252
Total allowed: $1,412,741

What Medicare pays for HCPCS G0407

Across 22,185 services billed by 252 providers to 10,370 beneficiaries, Medicare allowed an average of $63.68 per service. That is 2.1 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 G0407

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	10,052	3,482	$57.11	57
Neurology	2,541	1,791	$69.79	49
Psychiatry	2,503	1,352	$68.55	43
Infectious Disease	2,301	1,325	$68.45	32
Nephrology	1,743	605	$66.79	23
Internal Medicine	1,062	555	$69.15	13
Family Practice	485	372	$79.01	2
Cardiology	373	261	$70.14	6
Pulmonary Disease	274	148	$67.12	7
Physician Assistant	254	160	$58.82	6
Endocrinology	234	46	$74.66	1
Critical Care (Intensivists)	123	83	$73.13	5
Hospitalist	95	62	$72.54	2
Geriatric Medicine	67	62	$76.09	2
Anesthesiology	46	39	$80.97	2

G0407 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
Texas	3,339	$65.23	$52.03	52
Oklahoma	3,053	$57.64	$47.50	9
Florida	2,543	$67.37	$53.32	33
Tennessee	2,380	$57.55	$48.24	10
Louisiana	1,225	$60.82	$50.58	9
Arkansas	1,022	$55.51	$47.00	5
California	988	$74.57	$53.48	11
Nevada	768	$65.14	$53.51	3
South Dakota	626	$64.44	$52.73	6
Arizona	552	$60.76	$48.57	5
Illinois	547	$73.62	$55.63	5
Michigan	512	$63.98	$50.51	7
Pennsylvania	408	$68.70	$55.42	4
Ohio	384	$66.51	$54.23	10
North Carolina	362	$67.82	$55.32	6
Georgia	354	$69.00	$54.94	6
Indiana	280	$67.51	$55.30	7
Mississippi	264	$56.75	$47.30	3
New York	258	$74.37	$53.86	9
Oregon	222	$67.02	$53.55	5
Vermont	221	$55.36	$47.34	1
Washington	213	$70.06	$52.40	8
Missouri	196	$68.42	$54.60	4
Maryland	180	$68.19	$55.04	3
Nebraska	179	$66.54	$55.24	6
New Jersey	149	$72.44	$54.25	5
Iowa	141	$57.62	$47.37	1
Virginia	123	$69.14	$55.24	2
Colorado	122	$62.69	$46.46	3
Kentucky	109	$56.92	$46.47	1
West Virginia	88	$66.67	$54.66	2
Alabama	78	$70.53	$55.72	1
Connecticut	77	$74.20	$55.77	2
Minnesota	72	$69.96	$40.59	2
South Carolina	60	$66.97	$55.81	1
Massachusetts	24	$70.69	$55.66	1
Utah	20	$65.59	$55.81	1
New Mexico	17	$68.60	$55.58	1
Montana	17	$66.56	$55.85	1
Idaho	12	$69.88	$55.62	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.