HCPCS G0428 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 • Filler Procedures |
| Complexity Level | High |
National average reimbursement for HCPCS G0428 by major payers:
$1,875.01
$54.00
$807.26
$471.08
| 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 G0428 | ||||||
United | G0428 | $398.00 | 1821279720 - NEW ORLEANS LA UPTOWN WEST BANK ENDOSCOPY ASC LLC, MGA GASTROINTESTINAL DIAGNOSTIC AND THERAPEUTIC CENTER | 205904530 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | G0428 | $420.00 | 1184697930 - THE ALEXANDRIA OPHTHALMOLOGY ASC LLC, WALLACE LASER AND SURGERY CENTER | 752830937 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | G0428 | $11474.00 | 1861650780 - CHILDRENS NATIONAL MEDICAL CENTER | 530196580 - CHILDRENS HOSPITAL | DC | Children's Hospital (282NC2000X) |
United | G0428 | $341.00 | 1588614036 - ST. HELENA PARISH HOSPITAL | 720627145 - (LA) ST HELENA PARISH HOSPITAL | LA | Critical Access Hospital (282NC0060X) |
United | G0428 | $1012.00 | 1225031495 - MONROE SURGICAL HOSPITAL, LLC | 721479756 - (LA) MONROE SURGICAL HOSPITAL | LA | General Acute Care Hospital (282N00000X) |
United | G0428 | $339.00 | 1144216847 - RIVER PARK ASC LLC | 721510504 - (LA) RIVER PARK ASC LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | G0428 | $523.00 | 1306281563 - VIVERE HEALTH NEW ORLEANS, LLC, VIVERE AUDUBON SURGERY CENTER | 300726133 - (LA) VIVERE HEALTH NEW ORLEANS LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | G0428 | $1858.00 | 1871927921 - BRFHH SHREVEPORT, LLC | 831173631 | LA | General Acute Care Hospital (282N00000X) |
United | G0428 | $4336.00 | 1437186111 - PIEDMONT ATHENS REGIONAL MEDICAL CENTER, INC. | 582179986 - (GA) PIEDMONT ATHENS REGIONAL MEDICAL CENTER INC | GA | General Acute Care Hospital (282N00000X) |
United | G0428 | $762.00 | 1588784649 - CHRISTUS HEALTH SOUTHWESTERN LOUISIANA, CHRISTUS ST. PATRICK HOSPITAL | 720411322 - (LA) CHRISTUS HEALTH SOUTHWESTERN LOUISIANA | LA | General Acute Care Hospital (282N00000X) |
United | G0428 | $1958.00 | 1740981430 - NORTHEAST GEORGIA MEDICAL CENTER HABERSHAM LLC | 922451946 | GA | General Acute Care Hospital (282N00000X) |
United | G0428 | $583.00 | 1699429415 - ST LUKE'S SURGERY CENTER, LLC | 873243012 - A POSITIVE FOCUS COUNSELING LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | G0428 | $583.00 | 1699429415 - ST LUKE'S SURGERY CENTER, LLC | 873243012 - A POSITIVE FOCUS COUNSELING LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | G0428 | $680.00 | 1588648315 - POINTE COUPEE PARISH HEALTH SERVICES DISTRICT NUMBER ONE, POINTE COUPEE GENERAL HOSPITAL | 721054801 | LA | Critical Access Hospital (282NC0060X) |
United | G0428 | $1900.00 | 1669542346 - NATCHITOCHES PARISH HOSPITAL SERVICE DISTRICT, NATCHITOCHES REGIONAL MEDICAL CENTER | 726013916 - (LA) NATCHITOCHES REGIONAL MEDICAL CENTER | LA | General Acute Care Hospital (282N00000X) |
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 G0428 vs. Other Filler Procedures Codes
The HCPCS G0428 code is part of the Procedures / Professional Services services used for Filler Procedures. 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 G0428 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 |
|---|---|---|
| G0427-HCPCS | Moderate | Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth |
| G0428-HCPCS | High | Collagen meniscus implant procedure for filling meniscal defects (e.g., CMI, collagen scaffold, Menaflex) |
| G0429-HCPCS | Low | Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (LDS) (e.g., as a result of highly active antiretroviral therapy) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G0428. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G0428 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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