How much does Medicare pay for HCPCS G0506?

Medicare allowed an average of $54.10 per service and paid $41.30 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $122.91, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does G0506 pay differently in an office than a hospital?

Yes. The allowed amount averaged $55.85 in an office setting and $40.74 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 G0506 most?

Nurse Practitioner, with 53,469 services from 733 clinicians. Next are Internal Medicine, Family Practice, Physician Assistant.

HCPCS G0506

Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service)

$54.10Medicare-allowed amount per service, averaged across 153,319 services

Providers submitted

$122.91

Asking price, not received

Medicare allowed

$54.10

The fee schedule figure

Medicare paid

$41.30

Balance is patient coinsurance

Providers submitted an average of $122.91 for this code and Medicare allowed $54.10 — 2.3× 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 $41.30 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $55.85
Hospital / facility: $40.74

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 135,575 services were billed in an office setting and 17,744 in a facility.

Services: 153,319
Beneficiaries: 144,719
Providers billing it: 1,918
Total allowed: $8,294,558

What Medicare pays for HCPCS G0506

Across 153,319 services billed by 1,918 providers to 144,719 beneficiaries, Medicare allowed an average of $54.10 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 G0506

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	53,469	51,174	$47.40	733
Internal Medicine	30,371	28,460	$61.94	417
Family Practice	23,372	21,528	$60.41	370
Physician Assistant	16,965	16,277	$42.76	115
Cardiology	8,683	7,645	$61.18	52
Physical Medicine and Rehabilitation	3,288	3,084	$43.52	12
Rheumatology	2,942	2,927	$69.71	26
Emergency Medicine	2,244	2,180	$66.57	14
Pulmonary Disease	1,633	1,585	$60.34	17
General Practice	1,599	1,359	$53.13	16
Nephrology	1,522	1,497	$58.40	23
Geriatric Medicine	1,110	1,094	$64.50	22
Pain Management	878	838	$47.57	6
Endocrinology	850	841	$64.74	18
Neurology	658	648	$67.04	13

G0506 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
New York	33,842	$57.09	$44.38	177
Florida	19,043	$48.57	$42.24	171
Texas	14,979	$55.98	$43.68	214
California	14,198	$63.62	$44.04	193
Illinois	11,211	$49.42	$37.46	129
Georgia	5,623	$49.39	$41.12	92
Michigan	5,299	$56.25	$41.02	70
New Jersey	4,702	$59.19	$42.47	75
Arizona	4,283	$53.50	$41.46	96
North Carolina	3,419	$53.65	$43.28	68
South Carolina	3,418	$52.74	$41.30	89
Maryland	3,250	$47.76	$40.31	29
Pennsylvania	2,310	$46.59	$40.60	28
Rhode Island	2,157	$38.45	$41.52	3
Virginia	2,069	$53.32	$39.20	42
Colorado	2,052	$52.75	$39.12	46
Nevada	1,774	$51.35	$40.61	11
New Mexico	1,502	$47.16	$37.42	22
Louisiana	1,486	$55.11	$45.81	35
Tennessee	1,446	$51.10	$39.61	29
Massachusetts	1,387	$59.26	$41.95	20
Indiana	1,320	$47.41	$37.84	27
Washington	1,320	$53.11	$38.27	22
Mississippi	1,181	$52.18	$42.58	27
Oklahoma	1,107	$54.69	$45.34	17
Kansas	878	$49.81	$38.45	6
Nebraska	830	$49.86	$42.45	18
Alabama	821	$55.12	$42.67	24
Ohio	715	$50.33	$37.88	11
Kentucky	647	$54.49	$39.20	14
New Hampshire	612	$53.20	$39.77	2
Delaware	604	$51.65	$39.63	13
Wisconsin	431	$48.78	$38.37	10
Arkansas	404	$57.14	$48.47	6
Minnesota	377	$55.57	$38.95	15
Hawaii	304	$59.16	$41.59	6
Missouri	295	$50.78	$41.41	6
Maine	263	$60.78	$45.49	3
Alaska	236	$65.80	$38.64	4
Idaho	232	$49.70	$38.19	9
Connecticut	216	$62.43	$44.54	9
Utah	199	$50.29	$39.92	6
Oregon	150	$50.07	$38.28	6
Iowa	143	$37.77	$34.73	3
Montana	115	$58.11	$45.69	5
Guam	104	$64.50	$45.01	1
West Virginia	103	$49.35	$35.58	2
Vermont	69	$58.60	$41.70	1
District of Columbia	67	$60.00	$43.03	2
AP	65	$44.87	$37.03	1
Wyoming	33	$60.55	$47.48	1
North Dakota	28	$51.61	$35.71	2

Related codes

G0500Moderate sedation services provided by the same physician or other qua$7.46
G0513Prolonged preventive service(s) (beyond the typical service time of th$61.53
G0508Telehealth consultation$205.18
G0523Management of a new patient$395.12
G0509Telehealth consultation$186.15
G0522Management of a new patient$235.00
G0520Management of new patient-caregiver dyad$274.70
G0514Prolonged preventive service(s) (beyond the typical service time of th$61.07
G0519Management of new patient-caregiver dyad$148.71

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.