How much does Medicare pay for HCPCS G0426?

Medicare allowed an average of $122.81 per service and paid $96.12 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $363.58, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does G0426 pay differently in an office than a hospital?

Yes. The allowed amount averaged $121.99 in an office setting and $127.17 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 G0426 most?

Neurology, with 17,817 services from 433 clinicians. Next are Nurse Practitioner, Psychiatry, Infectious Disease.

HCPCS G0426

Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth

$122.81Medicare-allowed amount per service, averaged across 34,771 services

Providers submitted

$363.58

Asking price, not received

Medicare allowed

$122.81

The fee schedule figure

Medicare paid

$96.12

Balance is patient coinsurance

Providers submitted an average of $363.58 for this code and Medicare allowed $122.81 — 3.0× 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 $96.12 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $121.99
Hospital / facility: $127.17

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 29,286 services were billed in an office setting and 5,485 in a facility.

Services: 34,771
Beneficiaries: 30,759
Providers billing it: 702
Total allowed: $4,270,227

What Medicare pays for HCPCS G0426

Across 34,771 services billed by 702 providers to 30,759 beneficiaries, Medicare allowed an average of $122.81 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 G0426

Specialty	Services	Beneficiaries	Avg allowed	Providers
Neurology	17,817	17,680	$127.13	433
Nurse Practitioner	10,710	7,052	$113.15	75
Psychiatry	3,086	3,029	$130.55	90
Infectious Disease	1,111	1,035	$125.57	36
Critical Care (Intensivists)	359	356	$126.96	9
Physician Assistant	328	321	$107.44	9
Nephrology	285	244	$122.24	12
Internal Medicine	255	250	$127.11	10
Family Practice	180	175	$119.22	6
Cardiology	178	172	$129.70	5
Hospitalist	162	150	$125.48	5
Geriatric Psychiatry	80	79	$123.43	1
Pulmonary Disease	65	65	$126.32	3
Neuropsychiatry	43	43	$120.69	1
Neurosurgery	27	27	$133.10	2

G0426 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
New York	7,271	$117.66	$86.40	23
Florida	6,365	$126.23	$97.97	139
Texas	2,879	$121.29	$94.27	67
California	1,296	$130.43	$96.82	32
Georgia	1,199	$118.40	$93.95	35
Missouri	1,166	$124.62	$98.49	20
Washington	1,110	$132.73	$96.21	23
Pennsylvania	1,109	$122.18	$99.01	38
North Carolina	1,090	$119.78	$95.68	26
Ohio	1,053	$122.19	$96.43	26
South Carolina	910	$117.62	$95.37	20
Tennessee	804	$114.48	$94.47	23
Nevada	720	$121.70	$98.41	6
Michigan	709	$127.26	$96.55	21
New Jersey	658	$127.40	$97.79	15
Virginia	521	$124.94	$98.41	12
Colorado	510	$128.42	$97.15	14
Illinois	504	$132.69	$99.44	13
Louisiana	457	$123.54	$97.01	13
Oregon	442	$129.14	$98.62	15
Oklahoma	428	$122.90	$96.20	11
Alabama	344	$124.58	$100.16	5
Wisconsin	329	$122.58	$95.71	7
Arizona	318	$125.24	$99.79	13
Minnesota	307	$117.69	$94.37	14
Massachusetts	229	$129.39	$97.52	10
Rhode Island	220	$133.38	$101.30	3
Mississippi	206	$116.11	$94.93	6
Maryland	205	$133.69	$100.01	4
Kentucky	188	$106.71	$87.00	4
Utah	165	$126.36	$100.40	5
Connecticut	153	$128.73	$96.90	5
Indiana	138	$123.65	$97.83	5
West Virginia	137	$124.66	$99.20	5
Idaho	123	$121.30	$100.19	2
Arkansas	120	$108.46	$86.93	3
South Dakota	94	$110.20	$89.98	3
Nebraska	70	$120.21	$98.17	3
Hawaii	38	$124.11	$101.58	2
Montana	35	$122.98	$99.56	2
New Mexico	34	$125.51	$101.52	2
Iowa	29	$113.30	$93.32	2
Puerto Rico	28	$119.34	$96.75	1
District of Columbia	27	$138.07	$97.52	2
Alaska	19	$169.58	$96.00	1
Delaware	14	$113.00	$86.29	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.