How much does Medicare pay for HCPCS G0472?

Medicare allowed an average of $45.12 per service and paid $45.12 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $121.41, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code G0472?

Hepatitis c antibody screening, for individual at high risk and other covered indication(s). It was billed 192,954 times to 192,750 Medicare beneficiaries by 628 providers in 2024.

Which specialty bills G0472 most?

Clinical Laboratory, with 177,808 services from 132 clinicians. Next are Family Practice, Internal Medicine, Nurse Practitioner.

HCPCS G0472

Hepatitis c antibody screening, for individual at high risk and other covered indication(s)

$45.12Medicare-allowed amount per service, averaged across 192,954 services

Providers submitted

$121.41

Asking price, not received

Medicare allowed

$45.12

The fee schedule figure

Medicare paid

$45.12

Balance is patient coinsurance

Providers submitted an average of $121.41 for this code and Medicare allowed $45.12 — 2.7× 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 $45.12 (100%); the rest is the patient’s coinsurance and deductible.

Services: 192,954
Beneficiaries: 192,750
Providers billing it: 628
Total allowed: $8,706,084

What Medicare pays for HCPCS G0472

Across 192,954 services billed by 628 providers to 192,750 beneficiaries, Medicare allowed an average of $45.12 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 G0472

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	177,808	177,614	$45.19	132
Family Practice	6,374	6,370	$43.05	221
Internal Medicine	5,296	5,295	$45.14	169
Nurse Practitioner	1,253	1,253	$44.91	54
Pathology	963	958	$45.42	4
Physician Assistant	782	782	$45.07	34
General Practice	216	216	$44.75	5
Hematology-Oncology	64	64	$45.42	1
Pediatric Medicine	53	53	$45.42	1
Endocrinology	44	44	$45.42	1
Geriatric Medicine	37	37	$45.42	2
Infectious Disease	20	20	$23.30	1
Rheumatology	16	16	$45.42	1
Hospitalist	15	15	$45.42	1
Obstetrics & Gynecology	13	13	$45.42	1

G0472 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
North Carolina	25,340	$45.41	$45.42	7
California	22,225	$45.27	$45.40	30
New Jersey	19,219	$45.41	$45.42	3
Texas	16,914	$44.07	$45.40	58
Arizona	12,237	$44.39	$45.42	40
Florida	11,740	$45.25	$45.42	10
Ohio	10,635	$45.31	$45.42	77
Alabama	8,349	$45.26	$45.42	2
Washington	7,624	$45.04	$45.42	32
Kansas	6,265	$45.39	$45.42	3
Massachusetts	5,850	$44.71	$45.42	45
Illinois	5,244	$45.42	$45.42	10
Georgia	5,037	$45.42	$45.42	7
Wisconsin	4,743	$45.33	$45.42	13
Tennessee	4,559	$45.14	$45.42	132
Colorado	4,162	$44.90	$44.91	19
Oregon	2,906	$45.09	$45.42	20
Pennsylvania	2,478	$45.42	$45.42	5
Virginia	2,295	$45.42	$45.42	16
Oklahoma	2,275	$45.39	$45.42	4
Kentucky	1,635	$45.42	$45.42	3
Minnesota	1,479	$44.94	$45.42	14
Indiana	1,362	$45.42	$45.42	2
New York	1,293	$45.24	$45.42	9
Iowa	1,236	$45.38	$45.42	8
Maryland	1,122	$45.42	$45.42	2
Nevada	1,042	$45.42	$45.42	1
Michigan	639	$45.36	$45.36	2
Hawaii	579	$45.42	$45.42	1
Louisiana	514	$45.42	$45.42	2
South Carolina	490	$45.23	$45.42	7
Maine	326	$45.42	$45.42	5
Connecticut	277	$45.42	$45.42	8
Arkansas	251	$43.66	$45.42	12
South Dakota	213	$45.42	$45.42	2
Missouri	100	$31.48	$45.42	6
Montana	89	$45.42	$45.42	1
North Dakota	87	$45.42	$45.42	2
Nebraska	52	$44.10	$45.42	3
New Hampshire	22	$45.42	$45.42	1
West Virginia	14	$45.42	$45.42	1
AE	13	$36.18	$45.42	1
Idaho	11	$31.36	$45.42	1
Mississippi	11	$45.42	$45.42	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.