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See a sample rate comparisonHCPCS G0454 Fee Schedule
Medicare rates as of October 2026
HCPCS G0454 is classified under Procedures / Professional Services, in the Miscellaneous Services subgroup.
Physician documentation of face-to-face visit for durable medical equipment determination performed by nurse practitioner, physician assistant or clinical nurse specialist
| Key Fact | Detail |
|---|---|
| Service Type | Procedures / Professional Services Miscellaneous Services |
| Medicare Fee Schedule | $9.02 national non-facility rate (2026)View Medicare rates for G0454 |
| Medicaid Fee Schedule | $8.625 median of the 4 states in the free previewView Medicaid rates for G0454 |
National average reimbursement for HCPCS G0454 by major payers:
$11.56
BCBS / Anthem
$11.88
UnitedHealthcare
$8.94
Aetna
$9.23
Cigna
Compare published rates across providers.
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HCPCS G0454
5 of 25 sample ratesHigher to lower in this preview
Hospital Authority Of Jefferson County And The City Of Louisville, Jefferson Hospital
Hospital Authority Of Jefferson County And The City Of Louisville
$23.51Published rateHospital Authority Of Mitchell County, Mitchell County Hospital
Hospital Authority Of Mitchell County
$20.28Published rateWillamette Community Health Solutions, Cascade Health Solutions
$12.47Published rateTaylor Regional Hospital
$11.35Published rateAlicia Encinas
Miguel A Arenas Md PC
$7.53Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS G0454 vs. Other Miscellaneous Services Codes
The table lists codes related to G0454. Select one to see its fee schedule.
| Code | Description |
|---|---|
| G0453-HCPCS | Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure) |
| G0454-HCPCS | Physician documentation of face-to-face visit for durable medical equipment determination performed by nurse practitioner, physician assistant or clinical nurse specialist |
| G0455-HCPCS | Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G0454. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G0454 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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