How much does Medicare pay for HCPCS G9886?

Medicare allowed an average of $24.50 per service and paid $24.50 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $45.06, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code G9886?

Behavioral counseling for diabetes prevention, in-person, group, 60 minutes. It was billed 5,387 times to 612 Medicare beneficiaries by 24 providers in 2024.

Does G9886 pay differently in an office than a hospital?

Yes. The allowed amount averaged $24.50 in an office setting and $24.50 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 G9886 most?

Medicare Diabetes Preventive Program, with 5,199 services from 23 clinicians. Next are Mass Immunizer Roster Biller.

HCPCS G9886

Behavioral counseling for diabetes prevention, in-person, group, 60 minutes

$24.50Medicare-allowed amount per service, averaged across 5,387 services

Providers submitted

$45.06

Asking price, not received

Medicare allowed

$24.50

The fee schedule figure

Medicare paid

$24.50

Balance is patient coinsurance

Providers submitted an average of $45.06 for this code and Medicare allowed $24.50 — 1.8× 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 $24.50 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $24.50
Hospital / facility: $24.50

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 4,536 services were billed in an office setting and 851 in a facility.

Services: 5,387
Beneficiaries: 612
Providers billing it: 24
Total allowed: $131,982

What Medicare pays for HCPCS G9886

Across 5,387 services billed by 24 providers to 612 beneficiaries, Medicare allowed an average of $24.50 per service. That is 8.8 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 G9886

Specialty	Services	Beneficiaries	Avg allowed	Providers
Medicare Diabetes Preventive Program	5,199	598	$24.50	23
Mass Immunizer Roster Biller	188	14	$24.50	1

G9886 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
Maryland	1,152	$24.50	$24.50	3
Illinois	710	$24.50	$24.50	1
South Carolina	505	$24.50	$24.50	1
Colorado	442	$24.50	$24.50	2
New Hampshire	396	$24.50	$24.50	1
Minnesota	268	$24.50	$24.50	1
Arizona	244	$24.50	$24.50	2
Florida	231	$24.43	$24.50	2
Delaware	223	$24.50	$24.50	1
Pennsylvania	196	$24.50	$24.50	1
Kansas	188	$24.50	$24.50	1
Iowa	175	$24.50	$24.50	1
Oregon	150	$24.50	$24.50	1
California	110	$24.50	$24.50	1
Massachusetts	106	$24.50	$24.50	1
Idaho	105	$24.50	$24.50	1
Michigan	101	$24.50	$24.50	1
Wisconsin	66	$24.50	$24.50	1
New Jersey	19	$24.50	$24.50	1

Related codes

G9887Behavioral counseling for diabetes prevention$24.50

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.