How much does Medicare pay for HCPCS G0520?

Medicare allowed an average of $274.70 per service and paid $274.70 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $461.09, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code G0520?

Management of new patient-caregiver dyad with dementia, moderate complexity, for use in cmmi model. It was billed 3,328 times to 1,432 Medicare beneficiaries by 49 providers in 2024.

Does G0520 pay differently in an office than a hospital?

Yes. The allowed amount averaged $274.55 in an office setting and $276.90 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 G0520 most?

Nurse Practitioner, with 1,126 services from 21 clinicians. Next are Geriatric Medicine, Internal Medicine, Hospitalist.

HCPCS G0520

Management of new patient-caregiver dyad with dementia, moderate complexity, for use in cmmi model

$274.70Medicare-allowed amount per service, averaged across 3,328 services

Providers submitted

$461.09

Asking price, not received

Medicare allowed

$274.70

The fee schedule figure

Medicare paid

$274.70

Balance is patient coinsurance

Providers submitted an average of $461.09 for this code and Medicare allowed $274.70 — 1.7× 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 $274.70 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $274.55
Hospital / facility: $276.90

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 3,110 services were billed in an office setting and 218 in a facility.

Services: 3,328
Beneficiaries: 1,432
Providers billing it: 49
Total allowed: $914,202

What Medicare pays for HCPCS G0520

Across 3,328 services billed by 49 providers to 1,432 beneficiaries, Medicare allowed an average of $274.70 per service. That is 2.3 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 G0520

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	1,126	503	$278.17	21
Geriatric Medicine	632	239	$272.26	8
Internal Medicine	456	215	$268.18	7
Hospitalist	403	134	$292.81	1
Family Practice	386	172	$262.23	4
Neurology	161	92	$263.85	4
Hospice and Palliative Care	97	52	$288.06	2
Pediatric Medicine	42	13	$253.33	1
Physician Assistant	25	12	$253.87	1

G0520 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	1,064	$292.90	$292.90	14
North Carolina	637	$257.47	$257.47	8
Florida	250	$272.39	$272.39	4
Texas	246	$262.96	$262.96	4
Kentucky	239	$261.61	$261.61	4
Virginia	166	$265.09	$265.09	2
Massachusetts	138	$269.36	$269.36	2
Louisiana	129	$263.31	$263.31	1
Arizona	116	$264.92	$264.92	1
New York	104	$313.16	$313.16	2
Connecticut	68	$286.21	$286.21	2
Colorado	59	$269.50	$269.50	1
Indiana	35	$254.14	$254.14	1
Illinois	26	$276.51	$276.51	1
Delaware	26	$269.24	$269.24	1
Oklahoma	25	$253.87	$253.87	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
G0509Telehealth consultation$186.15
G0522Management of a new patient$235.00
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.