How much does Medicare pay for HCPCS G2211?

Medicare allowed an average of $15.87 per service and paid $12.01 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $43.40, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does G2211 pay differently in an office than a hospital?

Yes. The allowed amount averaged $15.89 in an office setting and $15.68 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 G2211 most?

Family Practice, with 4,928,085 services from 28,681 clinicians. Next are Internal Medicine, Nurse Practitioner, Cardiology.

HCPCS G2211

Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's

$15.87Medicare-allowed amount per service, averaged across 24,627,539 services

Providers submitted

$43.40

Asking price, not received

Medicare allowed

$15.87

The fee schedule figure

Medicare paid

$12.01

Balance is patient coinsurance

Providers submitted an average of $43.40 for this code and Medicare allowed $15.87 — 2.7× 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 $12.01 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $15.89
Hospital / facility: $15.68

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. 22,280,505 services were billed in an office setting and 2,347,034 in a facility.

Services: 24,627,539
Beneficiaries: 15,345,728
Providers billing it: 138,770
Total allowed: $390,839,044

What Medicare pays for HCPCS G2211

Across 24,627,539 services billed by 138,770 providers to 15,345,728 beneficiaries, Medicare allowed an average of $15.87 per service. That is 1.6 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 G2211

Specialty	Services	Beneficiaries	Avg allowed	Providers
Family Practice	4,928,085	2,870,966	$16.04	28,681
Internal Medicine	4,559,572	2,636,710	$16.35	21,437
Nurse Practitioner	2,874,467	1,915,299	$13.59	24,195
Cardiology	1,589,858	1,117,744	$16.69	5,676
Urology	1,468,011	1,035,356	$16.59	3,948
Physician Assistant	1,224,967	849,157	$13.55	10,687
Hematology-Oncology	1,163,678	567,943	$16.37	4,132
Nephrology	1,010,239	604,098	$16.24	4,575
Rheumatology	858,362	500,804	$16.47	3,071
Endocrinology	810,335	543,803	$16.53	3,385
Neurology	723,560	503,978	$16.48	4,721
Interventional Cardiology	390,073	280,049	$16.41	1,416
Pulmonary Disease	380,561	271,322	$16.38	2,609
Medical Oncology	362,725	180,821	$16.33	1,595
Ophthalmology	251,855	179,074	$16.12	1,458

G2211 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	2,107,098	$17.06	$12.20	9,731
Florida	1,917,163	$16.02	$12.00	8,254
New York	1,581,165	$17.30	$12.06	8,377
Texas	1,578,637	$15.59	$11.76	8,788
Pennsylvania	1,291,385	$15.84	$11.73	7,849
Illinois	1,118,024	$16.27	$11.94	5,995
North Carolina	994,406	$15.00	$11.55	6,080
Virginia	914,436	$15.81	$11.70	4,000
New Jersey	830,236	$17.22	$12.17	3,613
Maryland	788,050	$16.55	$11.83	3,195
South Carolina	782,626	$15.13	$11.62	3,036
Ohio	756,250	$15.31	$11.77	6,142
Massachusetts	637,723	$16.32	$11.81	4,550
Georgia	633,365	$15.55	$11.70	3,310
Tennessee	566,751	$14.79	$11.51	3,071
Washington	545,703	$16.24	$11.82	4,088
Michigan	528,416	$15.92	$11.78	4,441
Arizona	523,449	$15.33	$11.72	2,504
Indiana	498,110	$14.89	$11.56	2,885
Missouri	387,489	$15.31	$11.75	2,781
Oklahoma	375,551	$14.83	$11.48	1,627
Wisconsin	360,316	$14.95	$11.53	3,309
Oregon	359,709	$15.64	$11.61	2,616
Alabama	342,187	$14.85	$11.72	2,120
Minnesota	330,539	$15.25	$11.76	3,899
Louisiana	325,193	$15.27	$11.79	1,670
Colorado	323,228	$15.73	$11.70	2,138
Mississippi	309,778	$14.76	$11.46	1,178
Iowa	303,665	$14.81	$11.62	1,630
Kentucky	298,096	$15.11	$11.56	1,811
Kansas	284,155	$15.03	$11.69	1,464
Arkansas	262,035	$14.63	$11.61	1,183
Utah	223,399	$14.94	$11.54	1,690
Connecticut	209,704	$16.85	$12.13	1,601
Delaware	150,057	$15.73	$11.70	489
Nebraska	138,435	$14.91	$11.74	932
Nevada	134,463	$15.19	$11.50	659
New Hampshire	127,435	$15.77	$11.87	820
Montana	101,934	$15.41	$11.45	606
South Dakota	99,943	$15.01	$11.55	473
Idaho	84,844	$14.72	$11.50	568
West Virginia	76,615	$15.29	$11.50	557
New Mexico	70,715	$15.40	$11.59	465
North Dakota	61,155	$15.19	$11.66	378
District of Columbia	60,844	$17.56	$12.19	469
Maine	54,702	$15.57	$11.59	517
Rhode Island	51,759	$16.06	$11.88	397
Hawaii	46,871	$16.21	$11.81	281
Alaska	32,609	$20.61	$11.78	204
Vermont	27,549	$15.40	$11.83	208
Wyoming	11,844	$15.41	$11.82	69
Guam	3,080	$16.15	$11.64	18
Puerto Rico	2,361	$16.03	$11.96	14
U.S. Virgin Islands	676	$15.61	$11.60	3
AP	542	$15.73	$11.62	6
AE	511	$18.02	$12.16	5

Related codes

G2212Prolonged office or other outpatient evaluation and management service$31.02
G2214Initial or subsequent psychiatric collaborative care management$52.38
G2252Brief communication technology-based service$25.76

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.