How much does Medicare pay for HCPCS G0427?

Medicare allowed an average of $177.59 per service and paid $139.47 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $553.68, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does G0427 pay differently in an office than a hospital?

Yes. The allowed amount averaged $177.46 in an office setting and $178.98 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 G0427 most?

Neurology, with 14,988 services from 260 clinicians. Next are Infectious Disease, Nurse Practitioner, Psychiatry.

HCPCS G0427

Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth

$177.59Medicare-allowed amount per service, averaged across 26,350 services

Providers submitted

$553.68

Asking price, not received

Medicare allowed

$177.59

The fee schedule figure

Medicare paid

$139.47

Balance is patient coinsurance

Providers submitted an average of $553.68 for this code and Medicare allowed $177.59 — 3.1× 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 $139.47 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $177.46
Hospital / facility: $178.98

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 24,150 services were billed in an office setting and 2,200 in a facility.

Services: 26,350
Beneficiaries: 25,775
Providers billing it: 517
Total allowed: $4,679,497

What Medicare pays for HCPCS G0427

Across 26,350 services billed by 517 providers to 25,775 beneficiaries, Medicare allowed an average of $177.59 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 G0427

Specialty	Services	Beneficiaries	Avg allowed	Providers
Neurology	14,988	14,863	$181.75	260
Infectious Disease	2,850	2,752	$179.18	53
Nurse Practitioner	2,641	2,521	$148.35	64
Psychiatry	1,892	1,823	$183.26	52
Internal Medicine	1,688	1,633	$178.87	33
Hospitalist	380	355	$177.76	9
Nephrology	340	304	$176.85	7
Pulmonary Disease	290	286	$174.32	11
Critical Care (Intensivists)	267	265	$182.33	6
Family Practice	264	244	$173.48	3
Cardiology	211	210	$185.98	4
Physician Assistant	157	148	$148.45	5
Neurosurgery	97	96	$187.36	1
Sleep Medicine	86	85	$176.34	1
Emergency Medicine	63	63	$175.61	2

G0427 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	3,828	$175.76	$138.02	69
Florida	1,848	$181.77	$139.47	39
Ohio	1,588	$176.13	$142.30	38
Tennessee	1,362	$168.94	$136.52	30
California	1,289	$184.99	$138.18	33
Illinois	1,180	$186.27	$142.18	14
Pennsylvania	1,085	$176.87	$140.83	26
Georgia	1,051	$180.84	$141.34	18
Oklahoma	967	$171.68	$135.81	13
Louisiana	928	$164.36	$132.38	23
North Carolina	895	$171.04	$139.32	18
Massachusetts	843	$188.35	$141.83	13
Oregon	777	$178.68	$140.64	9
South Dakota	681	$173.37	$134.79	10
New York	600	$191.72	$140.56	11
South Carolina	522	$164.63	$134.64	13
New Jersey	520	$195.13	$142.34	6
Minnesota	516	$174.11	$136.12	13
Virginia	464	$180.89	$139.11	8
Wisconsin	460	$178.65	$138.27	5
Michigan	455	$179.70	$140.86	10
Rhode Island	452	$189.92	$143.29	1
Arizona	443	$177.10	$141.74	13
Missouri	423	$176.37	$139.87	14
Nevada	365	$175.05	$138.63	6
Kentucky	294	$171.81	$141.83	1
Alabama	283	$180.52	$136.26	3
Indiana	273	$185.86	$143.14	6
Maryland	265	$180.93	$137.93	7
Arkansas	217	$145.54	$122.58	6
Idaho	179	$174.61	$143.32	2
Connecticut	179	$190.47	$141.95	3
Colorado	168	$177.51	$135.21	6
Hawaii	142	$187.58	$143.32	2
New Mexico	138	$169.68	$128.47	4
Utah	132	$174.41	$139.02	6
Nebraska	112	$177.60	$141.04	3
West Virginia	79	$175.93	$143.53	1
Mississippi	74	$149.52	$121.73	2
Puerto Rico	69	$172.41	$138.77	1
Vermont	59	$148.39	$124.69	2
Montana	48	$181.02	$137.22	2
Iowa	42	$154.23	$127.26	3
Washington	40	$186.82	$141.21	3
North Dakota	15	$148.70	$113.74	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.