How much does Medicare pay for HCPCS G0454?

Medicare allowed an average of $8.41 per service and paid $6.35 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $14.83, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does G0454 pay differently in an office than a hospital?

Yes. The allowed amount averaged $8.43 in an office setting and $8.18 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 G0454 most?

Internal Medicine, with 1,001 services from 9 clinicians. Next are Pulmonary Disease, Sleep Medicine, Physician Assistant.

HCPCS G0454

Physician documentation of face-to-face visit for durable medical equipment determination performed by nurse practitioner, physician assistant or clinical nurse specialist

$8.41Medicare-allowed amount per service, averaged across 1,681 services

Providers submitted

$14.83

Asking price, not received

Medicare allowed

$8.41

The fee schedule figure

Medicare paid

$6.35

Balance is patient coinsurance

Providers submitted an average of $14.83 for this code and Medicare allowed $8.41 — 1.8× 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 $6.35 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $8.43
Hospital / facility: $8.18

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. 1,562 services were billed in an office setting and 119 in a facility.

Services: 1,681
Beneficiaries: 1,512
Providers billing it: 21
Total allowed: $14,137

What Medicare pays for HCPCS G0454

Across 1,681 services billed by 21 providers to 1,512 beneficiaries, Medicare allowed an average of $8.41 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 G0454

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	1,001	913	$8.51	9
Pulmonary Disease	416	375	$8.53	7
Sleep Medicine	156	152	$8.16	2
Physician Assistant	78	47	$7.33	2
Pain Management	30	25	$7.54	1

G0454 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	610	$8.51	$6.58	1
Texas	388	$8.53	$6.29	3
Maine	146	$8.42	$6.02	6
North Carolina	135	$8.50	$6.68	2
Nebraska	79	$8.04	$6.29	1
Kentucky	78	$8.20	$6.27	1
Tennessee	78	$8.12	$6.62	1
Connecticut	64	$7.21	$5.72	1
Pennsylvania	61	$8.83	$6.33	2
California	15	$8.69	$5.88	1
New Jersey	14	$7.90	$5.77	1
New Hampshire	13	$8.42	$5.23	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.