How much does Medicare pay for HCPCS G0442?

Medicare allowed an average of $17.96 per service and paid $17.96 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $40.63, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code G0442?

Annual alcohol misuse screening, 5 to 15 minutes. It was billed 983,643 times to 983,180 Medicare beneficiaries by 10,233 providers in 2024.

Does G0442 pay differently in an office than a hospital?

Yes. The allowed amount averaged $18.04 in an office setting and $8.37 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 G0442 most?

Internal Medicine, with 418,172 services from 3,460 clinicians. Next are Family Practice, Nurse Practitioner, Physician Assistant.

HCPCS G0442

Annual alcohol misuse screening, 5 to 15 minutes

$17.96Medicare-allowed amount per service, averaged across 983,643 services

Providers submitted

$40.63

Asking price, not received

Medicare allowed

$17.96

The fee schedule figure

Medicare paid

$17.96

Balance is patient coinsurance

Providers submitted an average of $40.63 for this code and Medicare allowed $17.96 — 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 $17.96 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $18.04
Hospital / facility: $8.37

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 975,907 services were billed in an office setting and 7,736 in a facility.

Services: 983,643
Beneficiaries: 983,180
Providers billing it: 10,233
Total allowed: $17,666,228

What Medicare pays for HCPCS G0442

Across 983,643 services billed by 10,233 providers to 983,180 beneficiaries, Medicare allowed an average of $17.96 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 G0442

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	418,172	418,041	$18.63	3,460
Family Practice	395,603	395,367	$18.18	3,629
Nurse Practitioner	102,562	102,522	$14.96	2,084
Physician Assistant	35,629	35,619	$15.14	715
General Practice	17,224	17,183	$19.24	160
Geriatric Medicine	4,029	4,028	$18.52	36
Obstetrics & Gynecology	2,314	2,314	$18.72	38
Cardiology	1,571	1,571	$20.76	14
Pediatric Medicine	1,145	1,145	$18.75	20
Endocrinology	866	863	$19.94	8
Hospitalist	842	842	$19.64	17
Psychiatry	823	823	$19.79	2
Emergency Medicine	502	501	$19.53	9
Pulmonary Disease	477	477	$21.45	7
Diagnostic Radiology	475	475	$21.78	1

G0442 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	190,306	$17.93	$18.20	1,615
California	87,045	$20.24	$18.09	744
Texas	74,702	$17.51	$17.93	848
Arizona	62,211	$17.31	$17.71	560
New York	54,188	$20.08	$18.15	681
Massachusetts	48,088	$19.16	$17.53	681
Maryland	40,607	$19.68	$18.26	290
Pennsylvania	35,601	$18.31	$18.17	339
Georgia	34,112	$17.08	$18.13	375
New Jersey	34,009	$20.41	$18.37	315
North Carolina	30,755	$16.42	$17.25	444
Mississippi	23,764	$13.96	$15.31	214
Alabama	22,941	$16.28	$18.11	287
Illinois	21,232	$18.98	$18.37	226
Tennessee	20,885	$16.49	$17.92	207
South Carolina	19,809	$15.76	$16.91	161
Ohio	16,320	$15.87	$16.79	202
Nevada	15,453	$17.99	$18.12	139
Michigan	14,864	$18.02	$18.38	195
Arkansas	14,514	$15.91	$17.79	145
Virginia	12,522	$18.52	$18.17	125
Oklahoma	12,255	$16.49	$17.62	157
Washington	9,584	$14.67	$14.96	130
Oregon	9,578	$14.90	$16.24	174
Kansas	9,307	$17.00	$17.98	72
Indiana	8,697	$17.37	$18.24	72
Connecticut	6,817	$19.35	$17.81	119
Kentucky	6,622	$15.25	$17.17	82
Colorado	6,567	$18.66	$18.21	95
Louisiana	5,125	$16.72	$18.11	62
Delaware	4,956	$17.96	$18.07	40
New Mexico	3,924	$15.89	$17.44	63
Nebraska	3,432	$16.41	$17.61	53
Missouri	3,268	$16.23	$17.73	34
Montana	2,295	$18.37	$18.40	10
Rhode Island	2,021	$18.38	$17.83	33
Wisconsin	1,980	$17.34	$17.78	36
Vermont	1,909	$17.59	$17.51	20
West Virginia	1,694	$15.91	$17.28	28
Idaho	1,585	$14.39	$16.03	27
Iowa	1,451	$16.36	$17.64	24
New Hampshire	1,417	$18.19	$17.72	32
District of Columbia	1,285	$20.55	$18.57	8
Utah	1,106	$17.15	$17.79	22
Hawaii	1,057	$13.70	$12.71	12
Minnesota	751	$17.67	$17.74	13
North Dakota	319	$17.33	$18.55	2
U.S. Virgin Islands	211	$17.12	$18.34	3
Maine	183	$19.25	$18.55	6
Alaska	150	$19.87	$16.88	4
Puerto Rico	136	$17.72	$18.51	6
Wyoming	33	$18.45	$18.53	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
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
G0402Initial preventive physical examination; face-to-face visit$158.02

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.