How much does Medicare pay for HCPCS G0513?

Medicare allowed an average of $61.53 per service and paid $61.53 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $119.23, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does G0513 pay differently in an office than a hospital?

Yes. The allowed amount averaged $61.52 in an office setting and $61.84 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 G0513 most?

Internal Medicine, with 8,900 services from 94 clinicians. Next are Family Practice, Nurse Practitioner, General Practice.

HCPCS G0513

Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preve

$61.53Medicare-allowed amount per service, averaged across 21,748 services

Providers submitted

$119.23

Asking price, not received

Medicare allowed

$61.53

The fee schedule figure

Medicare paid

$61.53

Balance is patient coinsurance

Providers submitted an average of $119.23 for this code and Medicare allowed $61.53 — 1.9× 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 $61.53 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $61.52
Hospital / facility: $61.84

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 21,419 services were billed in an office setting and 329 in a facility.

Services: 21,748
Beneficiaries: 21,744
Providers billing it: 261
Total allowed: $1,338,154

What Medicare pays for HCPCS G0513

Across 21,748 services billed by 261 providers to 21,744 beneficiaries, Medicare allowed an average of $61.53 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 G0513

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	8,900	8,899	$62.25	94
Family Practice	5,537	5,535	$62.50	69
Nurse Practitioner	2,599	2,598	$52.75	67
General Practice	2,390	2,390	$65.31	5
Psychiatry	970	970	$65.99	2
Physician Assistant	535	535	$53.29	14
Diagnostic Radiology	329	329	$67.75	1
Orthopedic Surgery	225	225	$60.97	1
Preventive Medicine	108	108	$64.83	1
Obstetrics & Gynecology	66	66	$60.88	2
Hospitalist	27	27	$59.40	1
Nephrology	25	25	$61.63	2
Cardiology	21	21	$59.74	1
Geriatric Medicine	16	16	$56.74	1

G0513 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
California	4,853	$64.62	$61.20	22
Illinois	3,095	$61.79	$57.43	29
Texas	2,723	$58.36	$58.10	44
Maryland	991	$64.63	$61.25	10
Georgia	900	$60.78	$59.21	13
District of Columbia	845	$66.31	$61.48	1
Colorado	794	$61.34	$61.42	11
Pennsylvania	721	$60.81	$58.71	11
New York	612	$62.77	$56.96	7
Washington	606	$61.78	$61.54	2
Montana	567	$61.47	$61.54	1
New Jersey	503	$64.54	$61.29	12
Florida	502	$61.32	$61.46	7
New Hampshire	454	$55.50	$55.33	15
Arizona	378	$58.31	$59.18	3
Connecticut	327	$62.26	$59.78	8
Nevada	317	$54.50	$55.88	8
Virginia	306	$63.11	$61.58	3
Indiana	282	$60.74	$61.33	3
Kentucky	259	$55.51	$57.23	5
Massachusetts	209	$62.29	$61.24	3
Alabama	206	$58.96	$61.41	6
North Carolina	187	$54.87	$55.55	5
Utah	183	$58.36	$59.91	2
Idaho	180	$51.91	$54.87	7
Minnesota	167	$51.60	$52.40	8
North Dakota	157	$58.32	$59.53	3
Oklahoma	146	$53.84	$61.49	2
Oregon	106	$60.10	$57.98	4
Michigan	61	$61.32	$59.67	2
Missouri	54	$49.55	$52.41	1
Iowa	22	$65.65	$61.66	1
New Mexico	21	$60.04	$61.52	1
Hawaii	14	$54.08	$52.41	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
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.