HCPCS G0472 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 • Other Services |
| Complexity Level | Low |
National average reimbursement for HCPCS G0472 by major payers:
$56.99
$21.07
$37.05
$40.72
| 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 G0472 | ||||||
United | G0472 | $19.46 | 1245868835 - AUSTIN PERRY | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Medical Physician Assistant (363AM0700X) |
United | G0472 | $17.50 | 1467406132 - EASTSIDE MEDICAL CENTER, LLC, PIEDMONT EASTSIDE MEDICAL CENTER | 582433432 | GA | General Acute Care Hospital (282N00000X) |
United | G0472 | $27.80 | 1306136551 - UJUKA ILOABUCHI | 582422542 - ATLANTA WOMENS HEALTH GROUP, P.C. | GA | Women's Hospital (282NW0100X) |
United | G0472 | $19.46 | 1730408071 - SALMA YAHYA | 931297405 - (OR) SISKIYOU PEDIATRIC CLINIC LLP | OR | Pediatrics Physician (208000000X) |
United | G0472 | $17.50 | 1295772259 - LAKEVIEW MEDICAL CENTER, LLC, LAKEVIEW REGIONAL MEDICAL CENTER | 621596506 | LA | General Acute Care Hospital (282N00000X) |
United | G0472 | $46.34 | 1598766495 - OUR LADY OF LOURDES REGIONAL MEDICAL CENTER,INC | 720423635 - OUR LADY OF LOURDES REGIONAL MEDICAL CENTER INC | LA | General Acute Care Hospital (282N00000X) |
United | G0472 | $93.91 | 1598964082 - EMORY HEALTHCARE | 582030692 - EMORY UNIVERSITY | GA | General Acute Care Hospital (282N00000X) |
United | G0472 | $27.80 | 1821017831 - BACON COUNTY HEALTH SERVICES, INC, BACON COUNTY RURAL HEALTH CLINIC | 582224545 - (GA) BACON COUNTY HEALTH SERVICES INC | GA | Rural Acute Care Hospital (282NR1301X) |
United | G0472 | $31.77 | 1306136551 - UJUKA ILOABUCHI | 881014763 | GA | Women's Hospital (282NW0100X) |
United | G0472 | $27.80 | 1881144889 - NGMC BARROW LLC, NGMC BARROW | 581177261 - (GA) GAINESVILLE RADIOLOGY GROUP | GA | General Acute Care Hospital (282N00000X) |
United | G0472 | $19.46 | 1700999521 - SISKIYOU PEDIATRIC CLINIC, LLP | 931297405 - (OR) SISKIYOU PEDIATRIC CLINIC LLP | OR | Pediatrics Physician (208000000X) |
United | G0472 | $19.46 | 1568446219 - STEVEN MARSHAK | 931297405 - (OR) SISKIYOU PEDIATRIC CLINIC LLP | OR | Pediatrics Physician (208000000X) |
United | G0472 | $38.50 | 1548887607 - SHAWNA LEE | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Family Nurse Practitioner (363LF0000X) |
United | G0472 | $8.15 | 1790715381 - NORTHSIDE HOSPITAL, INC., NORTHSIDE HOSPITAL DULUTH | 582002413 | GA | General Acute Care Hospital (282N00000X) |
United | G0472 | $93.91 | 1992799050 - GRADY MEMORIAL HOSPITAL CORPORATION, GRADY HEALTH SYSTEMS | 581537752 - EMORY UNIVERSITY | GA | 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 G0472 vs. Other Other Services Codes
The HCPCS G0472 code is part of the Procedures / Professional Services services used for Other 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 G0472 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 |
|---|---|---|
| G0471-HCPCS | Low | Collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (SNF) or by a laboratory on behalf of a home health agency (HHA) |
| G0472-HCPCS | Low | Hepatitis C antibody screening, for individual at high risk and other covered indication(s) |
| G0473-HCPCS | Low | Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G0472. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G0472 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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