How much does Medicare pay for HCPCS G2212?

Medicare allowed an average of $31.02 per service and paid $24.13 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $99.56, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does G2212 pay differently in an office than a hospital?

Yes. The allowed amount averaged $31.41 in an office setting and $29.87 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 G2212 most?

Neurology, with 128,495 services from 1,650 clinicians. Next are Nurse Practitioner, Internal Medicine, Family Practice.

HCPCS G2212

Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or

$31.02Medicare-allowed amount per service, averaged across 640,930 services

Providers submitted

$99.56

Asking price, not received

Medicare allowed

$31.02

The fee schedule figure

Medicare paid

$24.13

Balance is patient coinsurance

Providers submitted an average of $99.56 for this code and Medicare allowed $31.02 — 3.2× 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 $24.13 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $31.41
Hospital / facility: $29.87

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. 477,575 services were billed in an office setting and 163,355 in a facility.

Services: 640,930
Beneficiaries: 291,723
Providers billing it: 9,117
Total allowed: $19,881,649

What Medicare pays for HCPCS G2212

Across 640,930 services billed by 9,117 providers to 291,723 beneficiaries, Medicare allowed an average of $31.02 per service. That is 2.2 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 G2212

Specialty	Services	Beneficiaries	Avg allowed	Providers
Neurology	128,495	62,249	$32.53	1,650
Nurse Practitioner	105,383	47,424	$26.74	1,623
Internal Medicine	71,566	32,102	$32.28	917
Family Practice	38,496	13,908	$31.60	473
Hematology-Oncology	36,811	18,436	$32.02	606
Psychiatry	30,624	4,810	$32.11	195
Physician Assistant	28,647	14,611	$26.56	514
Geriatric Medicine	22,480	8,645	$31.65	200
Radiation Oncology	19,700	12,320	$31.14	343
Medical Oncology	15,223	7,469	$31.95	270
Cardiology	14,978	8,807	$32.35	251
Pulmonary Disease	14,431	7,845	$32.45	229
Hospice and Palliative Care	9,238	3,396	$32.24	108
Rheumatology	9,189	4,802	$33.33	148
Physical Medicine and Rehabilitation	8,208	2,978	$30.77	103

G2212 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	107,914	$33.58	$23.84	1,382
Massachusetts	39,062	$31.97	$23.60	513
Minnesota	37,154	$29.35	$23.41	560
Florida	34,615	$30.56	$23.75	421
New York	32,455	$33.33	$23.90	448
Texas	30,727	$31.00	$24.09	368
Maryland	27,015	$32.05	$24.04	316
Illinois	25,752	$31.93	$23.52	422
North Carolina	23,369	$29.12	$23.24	282
Washington	20,441	$32.15	$23.56	328
Arizona	17,809	$29.86	$23.65	246
Colorado	17,243	$29.96	$23.17	258
Pennsylvania	16,665	$30.64	$23.60	346
Utah	15,696	$27.95	$21.85	223
Wisconsin	13,957	$28.20	$22.64	238
Kansas	13,018	$28.83	$23.44	146
Virginia	12,606	$30.42	$23.12	202
Ohio	12,073	$28.37	$22.44	198
New Jersey	10,560	$33.57	$24.50	147
Oregon	8,640	$30.27	$23.36	166
Indiana	8,010	$28.52	$22.89	97
Missouri	7,934	$29.46	$23.16	138
Michigan	7,420	$30.16	$22.90	150
South Carolina	6,637	$30.01	$23.15	95
Idaho	6,531	$27.57	$22.33	77
Tennessee	6,344	$29.21	$23.54	100
Iowa	6,178	$27.04	$22.33	90
Georgia	6,114	$30.32	$23.27	125
Connecticut	5,532	$32.67	$24.31	81
Nevada	5,446	$30.61	$24.14	38
District of Columbia	5,326	$34.43	$24.45	77
Nebraska	4,920	$28.19	$22.99	69
Louisiana	4,234	$28.92	$23.64	66
Montana	4,227	$27.85	$21.53	74
Oklahoma	4,071	$28.96	$23.06	64
Maine	3,734	$29.50	$23.43	53
Vermont	3,507	$29.58	$23.50	37
New Hampshire	3,381	$29.82	$23.03	76
New Mexico	3,272	$30.06	$23.74	51
Kentucky	2,966	$29.02	$23.18	67
Alabama	2,238	$29.35	$23.73	35
West Virginia	2,188	$32.28	$24.29	21
South Dakota	2,038	$28.08	$22.25	28
Delaware	1,986	$30.78	$24.20	22
North Dakota	1,932	$27.31	$21.15	37
Hawaii	1,862	$31.58	$23.68	30
Alaska	1,763	$38.53	$22.91	35
Mississippi	1,506	$28.03	$22.20	27
Arkansas	1,319	$28.86	$24.26	19
Rhode Island	761	$31.09	$23.93	15
Wyoming	617	$27.54	$21.37	10
ZZ	108	$28.74	$24.22	1
Guam	42	$30.59	$24.23	1
U.S. Virgin Islands	15	$31.71	$25.23	1

Related codes

G2211Visit complexity inherent to evaluation and management associated$15.87
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.