How much does Medicare pay for HCPCS G0509?

Medicare allowed an average of $186.15 per service and paid $147.35 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $540.38, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does G0509 pay differently in an office than a hospital?

Yes. The allowed amount averaged $186.57 in an office setting and $183.10 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 G0509 most?

Critical Care (Intensivists), with 2,263 services from 29 clinicians. Next are Pulmonary Disease, Internal Medicine, Neurology.

HCPCS G0509

Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth

$186.15Medicare-allowed amount per service, averaged across 5,933 services

Providers submitted

$540.38

Asking price, not received

Medicare allowed

$186.15

The fee schedule figure

Medicare paid

$147.35

Balance is patient coinsurance

Providers submitted an average of $540.38 for this code and Medicare allowed $186.15 — 2.9× 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 $147.35 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $186.57
Hospital / facility: $183.10

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. 5,224 services were billed in an office setting and 709 in a facility.

Services: 5,933
Beneficiaries: 3,552
Providers billing it: 82
Total allowed: $1,104,428

What Medicare pays for HCPCS G0509

Across 5,933 services billed by 82 providers to 3,552 beneficiaries, Medicare allowed an average of $186.15 per service. That is 1.7 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 G0509

Specialty	Services	Beneficiaries	Avg allowed	Providers
Critical Care (Intensivists)	2,263	1,477	$187.83	29
Pulmonary Disease	1,485	642	$183.24	13
Internal Medicine	945	541	$192.23	12
Neurology	706	565	$182.01	17
Nephrology	136	90	$179.61	1
Infectious Disease	108	40	$196.36	2
Nurse Practitioner	79	42	$154.67	2
Hospitalist	57	41	$185.35	2
Emergency Medicine	55	40	$195.39	1
Anesthesiology	45	33	$185.58	1
General Surgery	30	26	$201.35	1
Physician Assistant	24	15	$148.53	1

G0509 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
Texas	1,858	$183.52	$146.16	13
Pennsylvania	795	$184.79	$144.60	13
New York	697	$191.16	$145.64	12
California	354	$189.41	$145.15	4
Virginia	304	$193.53	$146.96	4
Massachusetts	273	$190.67	$146.11	5
Florida	252	$193.73	$147.03	3
Kansas	189	$174.75	$146.81	1
Maryland	186	$196.84	$144.81	2
Michigan	151	$180.86	$146.74	1
Colorado	130	$181.96	$132.90	4
Tennessee	123	$163.34	$136.99	4
North Carolina	96	$177.39	$147.01	1
Hawaii	84	$189.78	$147.39	2
Oregon	81	$198.14	$144.96	2
Washington	67	$186.52	$146.76	1
Arizona	56	$175.90	$141.89	2
South Carolina	49	$194.52	$146.21	1
Connecticut	37	$193.01	$146.02	1
Arkansas	35	$177.72	$146.23	1
New Jersey	30	$201.35	$147.20	1
Oklahoma	27	$185.76	$147.01	1
Nebraska	20	$172.47	$137.05	1
Louisiana	20	$178.89	$147.19	1
Ohio	19	$185.75	$147.19	1

Related codes

G0500Moderate sedation services provided by the same physician or other qua$7.46
G0506Comprehensive assessment of and care planning for patients requiring c$54.10
G0513Prolonged preventive service(s) (beyond the typical service time of th$61.53
G0508Telehealth consultation$205.18
G0523Management of a new patient$395.12
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.