How much does Medicare pay for HCPCS G0471?

Medicare allowed an average of $10.56 per service and paid $10.56 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $19.23, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does G0471 pay differently in an office than a hospital?

Yes. The allowed amount averaged $10.51 in an office setting and $10.58 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 G0471 most?

Clinical Laboratory, with 2,121,895 services from 105 clinicians. Next are Internal Medicine, Nurse Practitioner, Family Practice.

HCPCS G0471

Collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (snf) or by a laboratory on behalf of a home health agency (hha)

$10.56Medicare-allowed amount per service, averaged across 2,124,275 services

Providers submitted

$19.23

Asking price, not received

Medicare allowed

$10.56

The fee schedule figure

Medicare paid

$10.56

Balance is patient coinsurance

Providers submitted an average of $19.23 for this code and Medicare allowed $10.56 — 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 $10.56 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $10.51
Hospital / facility: $10.58

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 755,899 services were billed in an office setting and 1,368,376 in a facility.

Services: 2,124,275
Beneficiaries: 488,587
Providers billing it: 108
Total allowed: $22,432,344

What Medicare pays for HCPCS G0471

Across 2,124,275 services billed by 108 providers to 488,587 beneficiaries, Medicare allowed an average of $10.56 per service. That is 4.3 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 G0471

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	2,121,895	487,995	$10.56	105
Internal Medicine	1,548	457	$10.59	1
Nurse Practitioner	717	96	$10.61	1
Family Practice	115	39	$10.61	1

G0471 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 Jersey	398,851	$10.57	$10.58	5
Florida	389,800	$10.54	$10.61	8
Ohio	264,055	$10.61	$10.61	5
Illinois	192,410	$10.61	$10.61	10
Texas	139,870	$10.55	$10.56	16
New York	95,610	$10.61	$10.61	2
Nevada	81,281	$10.61	$10.61	2
Maryland	78,018	$10.61	$10.61	2
California	75,139	$10.34	$10.61	9
Oklahoma	66,913	$10.54	$10.61	4
Georgia	63,809	$10.61	$10.61	2
Virginia	50,302	$10.61	$10.61	1
Pennsylvania	40,915	$10.61	$10.61	3
Kansas	26,460	$9.69	$10.61	2
Colorado	24,602	$10.61	$10.61	3
Rhode Island	20,073	$10.61	$10.61	1
Massachusetts	17,996	$10.61	$10.61	1
Alabama	15,870	$10.61	$10.61	1
Arkansas	13,009	$10.36	$10.61	1
Arizona	12,826	$10.61	$10.61	3
North Carolina	10,295	$10.60	$10.60	2
Tennessee	8,807	$10.61	$10.61	2
Wisconsin	6,943	$10.61	$10.61	2
Mississippi	5,622	$10.36	$10.61	1
South Carolina	5,553	$10.61	$10.61	1
North Dakota	4,690	$10.61	$10.61	2
Louisiana	3,875	$10.51	$10.51	3
Utah	2,892	$10.61	$10.61	2
Hawaii	1,642	$10.36	$10.61	1
Michigan	1,509	$10.61	$10.61	2
Missouri	1,382	$10.60	$10.60	2
Oregon	1,324	$10.61	$10.61	1
Washington	1,005	$10.61	$10.61	2
Connecticut	419	$10.61	$10.61	2
Indiana	260	$10.61	$10.61	1
Minnesota	248	$6.61	$10.61	1

Related codes

G0439Annual wellness visit$117.95
G0444Annual depression screening$17.80
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
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.