How much does Medicare pay for HCPCS G0420?

Medicare allowed an average of $97.90 per service and paid $74.72 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $223.93, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code G0420?

Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour. It was billed 3,196 times to 2,289 Medicare beneficiaries by 111 providers in 2024.

Which specialty bills G0420 most?

Nurse Practitioner, with 1,543 services from 51 clinicians. Next are Nephrology, Family Practice, Physician Assistant.

HCPCS G0420

Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour

$97.90Medicare-allowed amount per service, averaged across 3,196 services

Providers submitted

$223.93

Asking price, not received

Medicare allowed

$97.90

The fee schedule figure

Medicare paid

$74.72

Balance is patient coinsurance

Providers submitted an average of $223.93 for this code and Medicare allowed $97.90 — 2.3× 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 $74.72 (76%); the rest is the patient’s coinsurance and deductible.

Services: 3,196
Beneficiaries: 2,289
Providers billing it: 111
Total allowed: $312,888

What Medicare pays for HCPCS G0420

Across 3,196 services billed by 111 providers to 2,289 beneficiaries, Medicare allowed an average of $97.90 per service. That is 1.4 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 G0420

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	1,543	1,142	$89.48	51
Nephrology	1,239	828	$108.25	45
Family Practice	130	67	$105.70	3
Physician Assistant	127	113	$87.05	6
Internal Medicine	92	74	$100.13	4
Neurology	54	54	$105.77	1
Certified Clinical Nurse Specialist	11	11	$88.76	1

G0420 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	585	$96.67	$73.46	20
Illinois	297	$96.00	$72.17	6
New Jersey	280	$97.12	$76.09	12
New York	228	$111.33	$78.61	7
Florida	213	$99.43	$78.36	6
Nevada	208	$102.36	$80.88	4
North Carolina	205	$86.82	$65.71	10
Indiana	148	$88.40	$71.06	3
Georgia	146	$105.82	$81.64	4
California	139	$109.84	$81.18	6
Tennessee	115	$87.33	$64.03	6
Virginia	85	$107.90	$77.36	4
Alabama	80	$85.66	$67.61	2
Pennsylvania	80	$99.96	$75.81	4
Missouri	74	$95.27	$76.53	3
Louisiana	70	$106.75	$78.77	2
New Mexico	59	$88.05	$70.32	1
Mississippi	35	$85.20	$65.82	1
Maryland	30	$114.30	$79.70	2
Oregon	27	$89.78	$61.10	2
Michigan	24	$92.34	$71.68	2
Iowa	24	$85.73	$57.16	1
South Carolina	16	$102.52	$79.50	1
Arizona	14	$104.70	$78.52	1
Arkansas	14	$84.60	$67.13	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.