How much does Medicare pay for HCPCS G0480?

Medicare allowed an average of $110.33 per service and paid $110.33 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $287.31, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does G0480 pay differently in an office than a hospital?

Yes. The allowed amount averaged $110.33 in an office setting and $111.50 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 G0480 most?

Clinical Laboratory, with 459,259 services from 346 clinicians. Next are Nurse Practitioner, Interventional Pain Management, Pain Management.

HCPCS G0480

Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms

$110.33Medicare-allowed amount per service, averaged across 616,141 services

Providers submitted

$287.31

Asking price, not received

Medicare allowed

$110.33

The fee schedule figure

Medicare paid

$110.33

Balance is patient coinsurance

Providers submitted an average of $287.31 for this code and Medicare allowed $110.33 — 2.6× 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 $110.33 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $110.33
Hospital / facility: $111.50

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 615,630 services were billed in an office setting and 511 in a facility.

Services: 616,141
Beneficiaries: 343,271
Providers billing it: 1,595
Total allowed: $67,978,837

What Medicare pays for HCPCS G0480

Across 616,141 services billed by 1,595 providers to 343,271 beneficiaries, Medicare allowed an average of $110.33 per service. That is 1.8 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 G0480

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	459,259	255,906	$110.52	346
Nurse Practitioner	36,624	19,805	$108.59	455
Interventional Pain Management	32,967	18,121	$110.59	111
Pain Management	25,799	15,312	$110.31	157
Anesthesiology	17,732	10,139	$109.42	132
Physician Assistant	15,882	9,532	$109.07	192
Physical Medicine and Rehabilitation	12,589	7,149	$110.33	86
Family Practice	3,400	1,593	$110.05	29
Psychiatry	2,888	965	$111.63	12
Pathology	2,159	1,568	$110.64	4
Internal Medicine	1,988	955	$110.59	22
Emergency Medicine	1,526	534	$110.72	10
General Practice	665	277	$111.49	5
Neurology	519	279	$105.44	7
Clinic or Group Practice	348	195	$112.14	1

G0480 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	58,001	$109.28	$112.12	132
California	49,601	$111.43	$112.00	45
Georgia	48,272	$111.37	$112.14	117
Texas	45,400	$109.66	$112.14	152
New Jersey	42,541	$111.36	$112.14	64
Massachusetts	36,049	$111.68	$112.14	45
Pennsylvania	30,997	$111.51	$112.14	39
Michigan	29,480	$111.33	$112.11	30
Kentucky	26,745	$109.48	$112.14	119
Florida	24,414	$111.93	$112.14	102
Tennessee	21,035	$104.91	$112.14	86
New York	19,829	$109.78	$112.11	32
Indiana	19,622	$109.88	$112.13	54
Rhode Island	19,513	$111.64	$112.14	2
Nevada	15,675	$111.58	$112.14	16
Illinois	13,019	$112.02	$112.14	15
Washington	12,767	$111.14	$112.14	32
Alabama	12,408	$108.76	$112.14	31
Ohio	9,247	$100.48	$112.08	33
Maryland	8,804	$111.57	$112.14	48
Oklahoma	8,695	$110.36	$112.14	32
Kansas	6,728	$110.89	$112.14	6
Louisiana	6,279	$111.70	$112.14	29
Oregon	5,826	$108.47	$112.08	19
Arizona	5,327	$109.39	$112.14	10
South Carolina	4,781	$105.65	$112.14	48
Mississippi	4,774	$110.72	$112.14	34
Missouri	3,452	$111.28	$112.14	18
Virginia	3,210	$108.34	$112.11	17
Colorado	2,948	$110.79	$112.14	33
Minnesota	2,853	$105.13	$111.67	25
West Virginia	2,625	$111.32	$112.14	14
Connecticut	2,519	$111.22	$112.14	19
Wisconsin	2,435	$111.35	$112.14	11
Utah	2,422	$112.11	$112.14	6
Arkansas	1,581	$109.78	$112.14	25
Hawaii	1,191	$110.38	$112.14	4
New Mexico	915	$110.78	$112.14	7
Montana	812	$112.14	$112.14	6
New Hampshire	683	$107.51	$112.14	1
North Dakota	451	$110.36	$112.14	7
Nebraska	413	$111.09	$112.14	8
Alaska	409	$111.95	$112.14	6
Iowa	398	$97.53	$112.14	7
Idaho	364	$111.21	$112.14	4
District of Columbia	278	$112.14	$112.14	1
Maine	188	$111.87	$112.14	1
Vermont	119	$112.14	$112.14	1
South Dakota	29	$110.92	$112.14	1
Delaware	17	$106.86	$112.14	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
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.