How much does Medicare pay for HCPCS G0452?

Medicare allowed an average of $46.03 per service and paid $35.68 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $150.26, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code G0452?

Molecular pathology procedure; physician interpretation and report. It was billed 160,307 times to 114,957 Medicare beneficiaries by 641 providers in 2024.

Does G0452 pay differently in an office than a hospital?

Yes. The allowed amount averaged $46.22 in an office setting and $45.95 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 G0452 most?

Pathology, with 133,093 services from 555 clinicians. Next are Clinical Laboratory, Urology, Pediatric Medicine.

HCPCS G0452

Molecular pathology procedure; physician interpretation and report

$46.03Medicare-allowed amount per service, averaged across 160,307 services

Providers submitted

$150.26

Asking price, not received

Medicare allowed

$46.03

The fee schedule figure

Medicare paid

$35.68

Balance is patient coinsurance

Providers submitted an average of $150.26 for this code and Medicare allowed $46.03 — 3.3× 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 $35.68 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $46.22
Hospital / facility: $45.95

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. 43,483 services were billed in an office setting and 116,824 in a facility.

Services: 160,307
Beneficiaries: 114,957
Providers billing it: 641
Total allowed: $7,378,931

What Medicare pays for HCPCS G0452

Across 160,307 services billed by 641 providers to 114,957 beneficiaries, Medicare allowed an average of $46.03 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 G0452

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pathology	133,093	95,240	$46.14	555
Clinical Laboratory	23,508	16,995	$45.28	21
Urology	1,313	917	$48.52	13
Pediatric Medicine	779	296	$42.68	2
Hematology-Oncology	580	572	$49.26	26
Physician Assistant	201	169	$42.78	2
Medical Genetics and Genomics	198	188	$45.38	1
Internal Medicine	183	172	$48.46	6
Hematology	174	160	$48.89	5
Medical Oncology	106	104	$50.09	6
Nurse Practitioner	74	65	$41.30	1
Hospitalist	41	40	$50.32	1
Pain Management	38	21	$42.13	1
Nephrology	19	18	$48.98	1

G0452 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	22,259	$45.33	$34.41	56
New York	18,763	$49.43	$35.15	91
California	14,902	$49.32	$35.22	31
Arizona	14,825	$44.30	$33.02	4
Pennsylvania	12,789	$45.30	$35.06	36
Massachusetts	9,703	$47.93	$34.87	56
Tennessee	8,244	$42.49	$35.21	33
Illinois	7,873	$45.91	$34.40	38
Florida	7,257	$44.67	$34.97	39
New Jersey	6,430	$48.21	$34.31	32
North Carolina	5,807	$43.25	$34.84	14
Michigan	4,382	$45.02	$34.37	23
Connecticut	3,645	$47.39	$34.88	20
Minnesota	2,332	$44.31	$34.63	19
Maryland	2,147	$46.26	$34.95	8
Ohio	2,141	$43.48	$34.85	10
Oregon	1,914	$47.96	$34.39	15
Missouri	1,676	$44.45	$35.07	10
Virginia	1,596	$44.98	$34.68	4
Arkansas	1,466	$42.61	$35.24	7
Rhode Island	1,442	$47.83	$33.97	2
Iowa	1,387	$42.50	$35.12	7
Alabama	1,009	$43.39	$35.38	9
Washington	977	$37.55	$34.34	10
Colorado	732	$45.69	$35.50	8
New Mexico	597	$44.12	$33.91	7
Indiana	585	$41.04	$35.30	5
Kansas	572	$43.89	$35.69	2
Georgia	550	$44.33	$34.42	8
Nebraska	502	$41.55	$34.74	3
Maine	367	$44.94	$35.70	10
South Carolina	364	$43.70	$35.72	4
District of Columbia	278	$49.28	$35.65	5
Hawaii	214	$48.73	$34.92	1
Utah	163	$44.31	$34.45	6
Mississippi	138	$41.73	$34.90	1
Kentucky	131	$29.52	$35.45	2
Wisconsin	105	$42.71	$34.24	3
Oklahoma	22	$45.95	$38.16	1
Idaho	21	$42.31	$36.18	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.