HCPCS G0412 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 • Fracture Treatment |
| Complexity Level | Moderate |
National average reimbursement for HCPCS G0412 by major payers:
$919.24
$999.05
$758.72
$774.24
| 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 G0412 | ||||||
United | G0412 | $1174.45 | 1225014657 - CAROLINA RADIOLOGY ASSOCIATES LLC | 571049603 - (SC) CAROLINA RADIOLOGY ASSOCIATES, LLC | SC | Diagnostic Radiology Physician (2085R0202X) |
United | G0412 | $1272.33 | 1225014657 - CAROLINA RADIOLOGY ASSOCIATES LLC | 571049603 - (SC) CAROLINA RADIOLOGY ASSOCIATES, LLC | SC | Diagnostic Radiology Physician (2085R0202X) |
United | G0412 | $603.76 | 1225014657 - CAROLINA RADIOLOGY ASSOCIATES LLC | 571049603 - (SC) CAROLINA RADIOLOGY ASSOCIATES, LLC | SC | Diagnostic Radiology Physician (2085R0202X) |
United | G0412 | $1351.65 | 1457345910 - BRADLEY SMITH | 561079264 - EMERGEORTHO, P.A. | NC | Orthopaedic Surgery Physician (207X00000X) |
United | G0412 | $7224.00 | 1306265145 - MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, MARICOPA INTEGRATED HEATLH | 860830701 | AZ | Federally Qualified Health Center (FQHC) (261QF0400X) |
United | G0412 | $7224.00 | 1629840137 - MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, VALLEYWISE MOBILE HEALTH CLINIC | 860830701 | AZ | Federally Qualified Health Center (FQHC) (261QF0400X) |
United | G0412 | $27249.00 | 1417554528 - KECK MEDICAL CENTER OF USC | 851644866 - (CA) KECK MEDICAL CENTER OF USC | CA | General Acute Care Hospital (282N00000X) |
United | G0412 | $28641.00 | 1780653618 - H. LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE HOSPITAL, INC. | 593238634 - (FL) H LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE HOSPITAL INC | FL | Special Hospital (284300000X) |
United | G0412 | $7224.00 | 1003273855 - MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, MARICOPA SPECIAL HEALTH CARE DISTRICT | 860830701 | AZ | Adult Mental Health Clinic/Center (261QM0850X) |
United | G0412 | $8405.00 | 1306265145 - MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, MARICOPA INTEGRATED HEATLH | 860830701 | AZ | Federally Qualified Health Center (FQHC) (261QF0400X) |
United | G0412 | $8405.00 | 1770167108 - MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT | 860830701 | AZ | Multi-Specialty Clinic/Center (261QM1300X) |
United | G0412 | $609.28 | 1619087590 - MIGUEL ARENAS | 300394179 - (AZ) MIGUEL A ARENAS MD PC | AZ | Gastroenterology Physician (207RG0100X) |
United | G0412 | $8405.00 | 1821415902 - MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, MARICOPA INTEGRATED HEALTH | 860830701 | AZ | End-Stage Renal Disease (ESRD) Treatment Clinic/Center (261QE0700X) |
United | G0412 | $7224.00 | 1124710199 - MARICOPA COUNTY SPECIAL HEALLTH CARE DISTRICT, VALLEYWISE HEALTH | 860830701 | AZ | Adult Mental Health Clinic/Center (261QM0850X) |
United | G0412 | $21313.00 | 1790718500 - USC UNIVERSITY HOSPITAL, INC., USC HOSPITAL | 851644866 - (CA) KECK MEDICAL CENTER OF USC | CA | Psychiatric Hospital Unit (273R00000X) |
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 G0412 vs. Other Fracture Treatment Codes
The HCPCS G0412 code is part of the Procedures / Professional Services services used for Fracture Treatment. 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 G0412 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 |
|---|---|---|
| G0411-HCPCS | Low | Interactive group psychotherapy, in a partial hospitalization setting, approximately 45 to 50 minutes |
| G0412-HCPCS | Moderate | Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral or bilateral for pelvic bone fracture patterns which do not disrupt the pelvic ring includes internal fixation, when performed |
| G0413-HCPCS | High | Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, (includes ilium, sacroiliac joint and/or sacrum) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G0412. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G0412 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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