RxDoctor Payments Data

HCPCS G0475

Hiv antigen/antibody, combination assay, screening

$23.57Medicare-allowed amount per service, averaged across 21,777 services
Providers submitted
$134.01

Asking price, not received

Medicare allowed
$23.57

The fee schedule figure

Medicare paid
$23.57

Balance is patient coinsurance

Providers submitted an average of $134.01 for this code and Medicare allowed $23.575.7× 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 $23.57 (100%); the rest is the patient’s coinsurance and deductible.

Services
21,777

Medicare Part B, 2024

Beneficiaries
21,765
Providers billing it
88
Total allowed
$513,284

Services × allowed amount

What Medicare pays for HCPCS G0475

Across 21,777 services billed by 88 providers to 21,765 beneficiaries, Medicare allowed an average of $23.57 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 G0475

SpecialtyServicesBeneficiariesAvg allowedProviders
Clinical Laboratory21,45621,444$23.5777
Family Practice252252$23.608
General Practice4242$23.601
Internal Medicine1414$23.601
Physician Assistant1313$23.601

G0475 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.

StateServicesAllowedStandardized pmtProviders
California3,392$23.58$23.6010
North Carolina2,572$23.50$23.605
Texas2,227$23.54$23.606
Washington1,750$23.58$23.604
Ohio1,409$23.60$23.603
New Jersey1,326$23.60$23.602
Florida1,254$23.53$23.604
Massachusetts885$23.60$23.604
Alabama860$23.59$23.601
Kansas842$23.60$23.603
Illinois822$23.60$23.601
Minnesota682$23.57$23.603
Arizona567$23.60$23.603
Georgia552$23.60$23.601
Oregon471$23.60$23.603
Virginia468$23.60$23.602
Pennsylvania386$23.60$23.604
Oklahoma142$23.60$23.601
Maryland136$23.60$23.602
Colorado130$23.46$23.601
South Carolina122$23.60$23.602
New York101$23.60$23.601
South Dakota99$23.60$23.601
Wisconsin89$23.60$23.604
Indiana66$23.60$23.601
Iowa64$23.60$23.605
Nevada58$23.60$23.601
Tennessee57$23.60$23.601
Michigan54$23.60$23.601
Arkansas33$23.60$23.601
Louisiana33$23.60$23.601
Hawaii30$23.60$23.601
North Dakota29$23.60$23.601
West Virginia23$23.60$23.601
Kentucky17$23.60$23.601
Montana17$23.60$23.601
Nebraska12$23.60$23.601

Related codes

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.