How much does Medicare pay for HCPCS G0499?

Medicare allowed an average of $27.64 per service and paid $27.64 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $81.95, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Which specialty bills G0499 most?

Clinical Laboratory, with 802 services from 11 clinicians. Next are Rheumatology, Gastroenterology, Family Practice.

HCPCS G0499

Hepatitis b screening in non-pregnant, high risk individual includes hepatitis b surface antigen (hbsag), antibodies to hbsag (anti-hbs) and antibodies to hepatitis b core antigen (anti-hbc), and is followed by a neutralizing confirmatory test, when perfor

$27.64Medicare-allowed amount per service, averaged across 1,067 services

Providers submitted

$81.95

Asking price, not received

Medicare allowed

$27.64

The fee schedule figure

Medicare paid

$27.64

Balance is patient coinsurance

Providers submitted an average of $81.95 for this code and Medicare allowed $27.64 — 3.0× 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 $27.64 (100%); the rest is the patient’s coinsurance and deductible.

Services: 1,067
Beneficiaries: 1,065
Providers billing it: 21
Total allowed: $29,492

What Medicare pays for HCPCS G0499

Across 1,067 services billed by 21 providers to 1,065 beneficiaries, Medicare allowed an average of $27.64 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 G0499

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	802	800	$27.64	11
Rheumatology	168	168	$27.63	7
Gastroenterology	56	56	$27.70	1
Family Practice	30	30	$27.70	1
Internal Medicine	11	11	$27.70	1

G0499 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
Oregon	265	$27.70	$27.70	2
Hawaii	187	$27.70	$27.70	1
Massachusetts	171	$27.70	$27.70	5
Missouri	98	$27.70	$27.70	4
California	88	$27.70	$27.70	2
Arizona	80	$27.70	$27.70	1
Iowa	79	$27.41	$27.70	1
Indiana	38	$27.70	$27.70	1
Louisiana	18	$27.06	$27.70	1
Florida	17	$27.70	$27.70	1
Kansas	14	$27.70	$27.70	1
Minnesota	12	$25.39	$27.70	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.