HCPCS G0103 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Procedures / Professional Services • Screening Examinations and Disease Management Training |
| Complexity Level | Low |
National average reimbursement for HCPCS G0103 by major payers:

$18.20

$13.52

$25.09

$17.39
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS G0103 | ||||||
United | G0103 | $11.59 | 1629633649 - SOHAIL CHAUDHRY | 223834540 - (NJ) HEART VASCULAR ASSOCIATES OF NORTHERN JERSEY PA | NJ | Internal Medicine Physician (207R00000X) |
United | G0103 | $8.80 | 1821137225 - MICHAEL ROTHKOPF | 223734093 - (NJ) SOUTH MOUNTAIN MEDICAL CONSULTANTS P C | NJ | Internal Medicine Physician (207R00000X) |
United | G0103 | $7.71 | 1366889420 - TOVAH TRIPP | 141981653 - (NJ) HACKENSACK MERIDIAN HEALTH MEDICAL GROUP - PRIMARY CARE PC | NJ | Internal Medicine Physician (207R00000X) |
United | G0103 | $8.80 | 1932398047 - SOUTH MOUNTAIN MEDICAL CONSULTANTS P C, OSTEOPOROSIS PREVENTION | 223734093 - (NJ) SOUTH MOUNTAIN MEDICAL CONSULTANTS P C | NJ | Internal Medicine Physician (207R00000X) |
United | G0103 | $8.80 | 1821137225 - MICHAEL ROTHKOPF | 223734093 - (NJ) SOUTH MOUNTAIN MEDICAL CONSULTANTS P C | NJ | Internal Medicine Physician (207R00000X) |
United | G0103 | $8.80 | 1447290408 - STEPHEN FORD | 223734453 | NJ | Internal Medicine Physician (207R00000X) |
United | G0103 | $8.80 | 1639537582 - DARSAN PATEL | 223834540 - (NJ) HEART VASCULAR ASSOCIATES OF NORTHERN JERSEY PA | NJ | Internal Medicine Physician (207R00000X) |
United | G0103 | $8.80 | 1972750776 - SUMEET DHINDSA | 223834540 - (NJ) HEART VASCULAR ASSOCIATES OF NORTHERN JERSEY PA | NJ | Internal Medicine Physician (207R00000X) |
United | G0103 | $6.48 | 1669902995 - RADHIKA TAILOR | 223834540 - (NJ) HEART VASCULAR ASSOCIATES OF NORTHERN JERSEY PA | NJ | Internal Medicine Physician (207R00000X) |
United | G0103 | $8.80 | 1518487644 - ALLARICE LINAAC | 223834540 - (NJ) HEART VASCULAR ASSOCIATES OF NORTHERN JERSEY PA | NJ | Internal Medicine Physician (207R00000X) |
United | G0103 | $9.43 | 1205804127 - SHAHID FAROOQUI | 753121993 - (NJ) CRESCENT MULISPECIALITY GROUP LLC | NJ | Internal Medicine Physician (207R00000X) |
United | G0103 | $20.44 | 1376560110 - PRAMILA VEERASWAMY | 800756169 | NJ | Internal Medicine Physician (207R00000X) |
United | G0103 | $8.80 | 1487626370 - MARY HARRIS | 1487626370 - (NJ) MARY HARRIS | NJ | Internal Medicine Physician (207R00000X) |
United | G0103 | $9.60 | 1740215144 - ROBERT DENNISTON | 1740215144 - (NJ) ROBERT DENNISTON | NJ | Internal Medicine Physician (207R00000X) |
United | G0103 | $9.60 | 1740215144 - ROBERT DENNISTON | 1740215144 - (NJ) ROBERT DENNISTON | NJ | Internal Medicine Physician (207R00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS G0103 vs. Other Screening Examinations and Disease Management Training Codes
The HCPCS G0103 code is part of the Procedures / Professional Services services used for Screening Examinations and Disease Management Training. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS G0103 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| G0102-HCPCS | Low | Prostate cancer screening; digital rectal examination |
| G0103-HCPCS | Low | Prostate cancer screening; prostate specific antigen test (PSA) |
| G0104-HCPCS | Low | Colorectal cancer screening; flexible sigmoidoscopy |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G0103. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G0103 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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