HCPCS G0413 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Procedures / Professional Services • Fracture Treatment |
| Complexity Level | High |
National average reimbursement for HCPCS G0413 by major payers:
$1,289.39
$1,442.33
$1,249.77
$1,134.04
| 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 G0413 | ||||||
United | G0413 | $2131.85 | 1457345910 - BRADLEY SMITH | 561079264 - EMERGEORTHO, P.A. | NC | Orthopaedic Surgery Physician (207X00000X) |
United | G0413 | $1724.08 | 1225014657 - CAROLINA RADIOLOGY ASSOCIATES LLC | 571049603 - (SC) CAROLINA RADIOLOGY ASSOCIATES, LLC | SC | Diagnostic Radiology Physician (2085R0202X) |
United | G0413 | $881.84 | 1225014657 - CAROLINA RADIOLOGY ASSOCIATES LLC | 571049603 - (SC) CAROLINA RADIOLOGY ASSOCIATES, LLC | SC | Diagnostic Radiology Physician (2085R0202X) |
United | G0413 | $1724.08 | 1225014657 - CAROLINA RADIOLOGY ASSOCIATES LLC | 571049603 - (SC) CAROLINA RADIOLOGY ASSOCIATES, LLC | SC | Diagnostic Radiology Physician (2085R0202X) |
United | G0413 | $2659.16 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | G0413 | $1540.00 | 1073026639 - MID CITY SPECIALTY CENTER, LLC | 822996794 - (LA) MID CITY SPECIALTY CENTER LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | G0413 | $5532.00 | 1306281126 - UNIVERSITY HOSPITAL & CLINICS, INC., OCHSNER UNIVERSITY HOSPITAL & CLINICS | 462605366 - (LA) UNIVERSITY HOSPITAL & CLINICS INC | LA | General Acute Care Hospital (282N00000X) |
United | G0413 | $5999.00 | 1427536325 - UNIVERSITY HEALTH SHREVEPORT LLC, OCHSNER LSU HEALTH SHREVEPORT | 831173631 | LA | General Acute Care Hospital (282N00000X) |
United | G0413 | $8890.00 | 1518924109 - TERREBONNE PARISH HOSPITAL SERVICE DISTRICT #1, TERREBONNE GENERAL MEDICAL CENTER | 720880258 - (LA) TERREBONNE HOSPITAL SERVICE DISTRICT NO 1 | LA | General Acute Care Hospital (282N00000X) |
United | G0413 | $1759.00 | 1811378375 - ALEXANDRIA AMBULATORY SURGERY CENTER LP, ALEXANDRIA HEART & VASCULAR SURGERY CENTER | 471533012 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | G0413 | $2542.00 | 1497090740 - OLOL PONTCHARTRAIN SURGERY CENTER, LLC, OUR LADY OF THE LAKE PONTCHARTRAIN SURGERY CENTER | 461379031 - (LA) OLOL PONTCHARTRAIN SURGERY CENTE | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | G0413 | $1566.00 | 1528369972 - INSIGHT GROUP, LLC | 261871061 - (LA) INSIGHT GROUP LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | G0413 | $1772.00 | 1003062274 - ADVANCED SURGICAL CARE OF BATON ROUGE,LLC | 261476056 - (LA) ADVANCED SURGICAL CARE OF BATON ROUGELLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | G0413 | $1790.00 | 1245617562 - KAPLAN GENERAL HOSPITAL, INC. | 472540179 - (LA) KAPLAN GENERAL HOSPITAL INC | LA | Critical Access Hospital (282NC0060X) |
United | G0413 | $3021.00 | 1306265145 - MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, MARICOPA INTEGRATED HEATLH | 860830701 | AZ | Federally Qualified Health Center (FQHC) (261QF0400X) |
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 G0413 vs. Other Fracture Treatment Codes
The HCPCS G0413 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 G0413 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 |
|---|---|---|
| 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) |
| G0414-HCPCS | High | Open treatment of anterior pelvic bone fracture and/or dislocation for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation when performed (includes pubic symphysis and/or superior/inferior rami) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G0413. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G0413 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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