How much does Medicare pay for HCPCS G0481?

Medicare allowed an average of $152.51 per service and paid $152.51 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $416.31, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Which specialty bills G0481 most?

Clinical Laboratory, with 249,115 services from 254 clinicians. Next are Nurse Practitioner, Anesthesiology, Physician Assistant.

HCPCS G0481

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

$152.51Medicare-allowed amount per service, averaged across 455,037 services

Providers submitted

$416.31

Asking price, not received

Medicare allowed

$152.51

The fee schedule figure

Medicare paid

$152.51

Balance is patient coinsurance

Providers submitted an average of $416.31 for this code and Medicare allowed $152.51 — 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 $152.51 (100%); the rest is the patient’s coinsurance and deductible.

Services: 455,037
Beneficiaries: 259,038
Providers billing it: 1,718
Total allowed: $69,397,693

What Medicare pays for HCPCS G0481

Across 455,037 services billed by 1,718 providers to 259,038 beneficiaries, Medicare allowed an average of $152.51 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 G0481

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	249,115	142,017	$152.77	254
Nurse Practitioner	60,914	33,507	$152.29	493
Anesthesiology	31,707	18,598	$152.18	184
Physician Assistant	31,398	17,541	$152.32	259
Interventional Pain Management	25,552	14,136	$152.17	129
Pain Management	24,603	16,931	$152.20	199
Physical Medicine and Rehabilitation	18,953	10,372	$152.67	106
Family Practice	2,811	1,421	$149.93	28
Internal Medicine	2,728	1,029	$150.43	16
Emergency Medicine	2,220	931	$152.37	10
Pathology	1,071	719	$151.34	3
Psychiatry	976	376	$152.01	12
Neurology	805	563	$150.27	9
General Practice	731	236	$153.26	2
Addiction Medicine	657	252	$149.50	6

G0481 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	55,436	$152.73	$153.46	113
California	45,084	$152.93	$153.46	45
Florida	35,089	$152.71	$153.46	226
Maryland	31,687	$153.08	$153.46	104
New Jersey	28,181	$152.80	$153.46	63
Tennessee	26,999	$152.42	$153.46	69
Georgia	25,206	$152.02	$153.46	102
Kentucky	23,845	$152.65	$153.46	83
Pennsylvania	16,610	$152.90	$153.46	53
Texas	15,729	$152.11	$153.46	121
Michigan	15,214	$153.10	$153.46	34
New York	12,305	$153.24	$153.46	32
Arizona	9,664	$152.61	$153.46	51
Indiana	9,620	$151.61	$153.46	50
Nevada	9,537	$152.63	$153.46	26
Oklahoma	9,320	$151.67	$153.46	36
Alabama	9,228	$151.88	$153.46	29
Minnesota	7,484	$151.78	$153.46	70
Connecticut	6,155	$152.75	$153.46	18
South Carolina	5,986	$153.00	$153.46	31
Massachusetts	5,962	$151.88	$153.46	23
Utah	5,120	$153.10	$153.46	20
Washington	5,066	$147.98	$153.46	43
Ohio	4,716	$150.32	$153.46	38
Virginia	4,496	$152.39	$153.46	11
Illinois	4,131	$151.92	$153.46	18
Kansas	3,394	$153.10	$153.46	4
Arkansas	3,256	$151.65	$153.46	51
Louisiana	3,143	$152.05	$153.46	22
Mississippi	2,974	$147.77	$153.46	32
Alaska	2,800	$153.23	$153.46	12
Rhode Island	2,382	$152.56	$153.46	1
Oregon	1,813	$152.96	$153.46	14
Montana	1,254	$153.46	$153.46	7
New Mexico	1,126	$153.21	$153.46	7
Delaware	854	$151.93	$153.46	6
Idaho	714	$151.75	$153.46	9
Hawaii	680	$152.70	$153.46	2
Wisconsin	581	$152.25	$153.46	7
Missouri	475	$153.46	$153.46	8
North Dakota	468	$151.47	$153.46	5
Colorado	435	$150.35	$153.46	11
West Virginia	387	$152.42	$153.46	4
Iowa	194	$153.05	$153.46	3
Nebraska	124	$153.46	$153.46	1
New Hampshire	64	$153.46	$153.46	1
District of Columbia	49	$153.46	$153.46	2

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
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.