HCPCS G0454 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 • Miscellaneous Services |
| Complexity Level | Low |
National average reimbursement for HCPCS G0454 by major payers:
$11.56
$11.88
$8.94
$9.23
| 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 G0454 | ||||||
United | G0454 | $11.68 | 1396769964 - JULIE WEBSTER | 853861695 - MUSC COMMUNITY PHYSICIANS | SC | Body Imaging Physician (2085B0100X) |
United | G0454 | $19.48 | 1033165865 - DAVID EPSTEIN | 591212948 - (FL) RADIOLOGY ASSOCIATES OF CLEARWATER, P.A. | FL | Diagnostic Radiology Physician (2085R0202X) |
United | G0454 | $13.53 | 1225014657 - CAROLINA RADIOLOGY ASSOCIATES LLC | 571049603 - (SC) CAROLINA RADIOLOGY ASSOCIATES, LLC | SC | Diagnostic Radiology Physician (2085R0202X) |
United | G0454 | $12.14 | 1225014657 - CAROLINA RADIOLOGY ASSOCIATES LLC | 571049603 - (SC) CAROLINA RADIOLOGY ASSOCIATES, LLC | SC | Diagnostic Radiology Physician (2085R0202X) |
United | G0454 | $11.68 | 1396769964 - JULIE WEBSTER | 853861695 - MUSC COMMUNITY PHYSICIANS | SC | Body Imaging Physician (2085B0100X) |
United | G0454 | $9.65 | 1306540380 - KARLIE RYAN | 451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINE | AL | Family Nurse Practitioner (363LF0000X) |
United | G0454 | $25.26 | 1033165865 - DAVID EPSTEIN | 462439952 - (FL) BREVARD PHYSICIAN ASSOCIATES, PLLC | FL | Diagnostic Radiology Physician (2085R0202X) |
United | G0454 | $9.90 | 1396769964 - JULIE WEBSTER | 853861695 - MUSC COMMUNITY PHYSICIANS | SC | Body Imaging Physician (2085B0100X) |
United | G0454 | $12.14 | 1396769964 - JULIE WEBSTER | 571049603 - (SC) CAROLINA RADIOLOGY ASSOCIATES, LLC | SC | Body Imaging Physician (2085B0100X) |
United | G0454 | $12.14 | 1396769964 - JULIE WEBSTER | 571049603 - (SC) CAROLINA RADIOLOGY ASSOCIATES, LLC | SC | Body Imaging Physician (2085B0100X) |
United | G0454 | $9.90 | 1396769964 - JULIE WEBSTER | 853861695 - MUSC COMMUNITY PHYSICIANS | SC | Body Imaging Physician (2085B0100X) |
United | G0454 | $9.90 | 1396769964 - JULIE WEBSTER | 853861695 - MUSC COMMUNITY PHYSICIANS | SC | Body Imaging Physician (2085B0100X) |
United | G0454 | $9.65 | 1952557498 - JEREMY KELLEY | 451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINE | AL | Family Nurse Practitioner (363LF0000X) |
United | G0454 | $7.69 | 1225014657 - CAROLINA RADIOLOGY ASSOCIATES LLC | 571049603 - (SC) CAROLINA RADIOLOGY ASSOCIATES, LLC | SC | Diagnostic Radiology Physician (2085R0202X) |
United | G0454 | $19.48 | 1033165865 - DAVID EPSTEIN | 591212948 - (FL) RADIOLOGY ASSOCIATES OF CLEARWATER, P.A. | FL | Diagnostic Radiology Physician (2085R0202X) |
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 G0454 vs. Other Miscellaneous Services Codes
The HCPCS G0454 code is part of the Procedures / Professional Services services used for Miscellaneous Services. 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 G0454 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 |
|---|---|---|
| G0453-HCPCS | Low | 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 | Low | Physician documentation of face-to-face visit for durable medical equipment determination performed by nurse practitioner, physician assistant or clinical nurse specialist |
| G0455-HCPCS | Low | 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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