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See a sample rate comparisonHCPCS G0381 Fee Schedule
HCPCS G0381 is classified under Procedures / Professional Services, in the Hospital Observation and Emergency Services subgroup.
Level 2 hospital emergency department visit provided in a type B emergency department; (the ED must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 CFR 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)
| Key Fact | Detail |
|---|---|
| Service Type | Procedures / Professional Services Hospital Observation and Emergency Services |
| Hospital Outpatient Group (APC) | APC 5032 - Level 2 Type B ED Visits |
| Common Revenue Codes | 0450 |
| Medicaid Fee Schedule | View Medicaid rates for G0381 |
National average reimbursement for HCPCS G0381 by major payers:
$140.07
BCBS / Anthem
$68.10
UnitedHealthcare
$147.37
Aetna
$76.95
Cigna
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HCPCS G0381
5 of 25 sample ratesHigher to lower in this preview
Piedmont Athens Regional Medical Center, Inc.
Piedmont Athens Regional Medical Center Inc
$1,242.00Published rateClhg-Acadian, LLC, Acadian Medical Center
$492.00Published rateCandler Hospital Incorporated
$319.00Published rateParish Hospital Service District For The Parish Of Orleans, New Orleans East Hospital
$181.11Published rateSabine Medical Center Inc, Sabine Medical Center
$115.41Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS G0381 vs. Other Hospital Observation and Emergency Services Codes
The table lists codes related to G0381. Select one to see its fee schedule.
| Code | Description |
|---|---|
| G0380-HCPCS | Level 1 hospital emergency department visit provided in a type B emergency department; (the ED must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 CFR 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
| G0381-HCPCS | Level 2 hospital emergency department visit provided in a type B emergency department; (the ED must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 CFR 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
| G0382-HCPCS | Level 3 hospital emergency department visit provided in a type B emergency department; (the ED must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 CFR 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G0381. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G0381 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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Frequently Asked Questions
What APC is HCPCS G0381 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns HCPCS G0381 to APC 5032 (Level 2 Type B ED Visits). An APC groups outpatient services that Medicare pays at the same base rate.
Which revenue codes are billed with HCPCS G0381?
Hospital price transparency files list HCPCS G0381 under these revenue codes: 0450. A revenue code names the hospital department or charge category for the line; it does not change what the service is.