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See a sample rate comparisonHCPCS G0038 Fee Schedule
HCPCS G0038 is classified under Procedures / Professional Services, in the MIPS Measures subgroup.
Clinician determines patient does not require referral
| Key Fact | Detail |
|---|---|
| Service Type | Procedures / Professional Services MIPS Measures |
| Complexity Level | Low |
National average reimbursement for HCPCS G0038 by major payers:
$71.93
BCBS / Anthem
$657.67
UnitedHealthcare
$1,417.82
Aetna
$534.94
Cigna
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HCPCS G0038
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Payer Contract Negotiation
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See a sample payer proposalHCPCS G0038 vs. Other MIPS Measures Codes
The table lists codes related to G0038. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| G0037-HCPCS | Low | On date of encounter, patient is not able to participate in assessment or screening, including non-verbal patients, delirious, severely aphasic, severely developmentally delayed, severe visual or hearing impairment and for those patients, no knowledgeable informant available |
| G0038-HCPCS | Low | Clinician determines patient does not require referral |
| G0039-HCPCS | Low | Patient not referred, reason not otherwise specified |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G0038. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G0038 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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