HCPCS G0511 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 G0511 by major payers:
$81.04
$82.86
$71.49
$77.84
| 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 G0511 | ||||||
United | G0511 | $66.76 | 1720079270 - FAKHIR ELMASRI | 591262719 - (FL) RADIOLOGY AND IMAGING SPECIALISTS OF LAKELAND, P.A. | FL | Vascular & Interventional Radiology Physician (2085R0204X) |
United | G0511 | $126.44 | 1720079270 - FAKHIR ELMASRI | 592579847 - (FL) UNIVERSITY OF MIAMI | FL | Vascular & Interventional Radiology Physician (2085R0204X) |
United | G0511 | $110.80 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | G0511 | $73.08 | 1942682653 - RABIA JAMY | 752654757 - TEXAS NEUROLOGY, P. A. | TX | Neurology Physician (2084N0400X) |
United | G0511 | $51.40 | 1881804540 - JAMIR MIRELES | 264219582 - (TX) JAMIR E MIRELES MD LLC | TX | Family Medicine Physician (207Q00000X) |
United | G0511 | $72.43 | 1023337516 - ELIZABETH PRATHER | 462456505 - PRIVIA MEDICAL GROUP - GULF COAST | TX | Family Nurse Practitioner (363LF0000X) |
United | G0511 | $68.51 | 1730419904 - TEXAS RADIOLOGY ASSOCIATES LLP | 751459885 - TEXAS RADIOLOGY ASSOCIATES, LLP | TX | Diagnostic Radiology Physician (2085R0202X) |
United | G0511 | $91.80 | 1003877929 - VAN NGO | 742958277 - SCOTT & WHITE CLINIC | TX | Family Medicine Physician (207Q00000X) |
United | G0511 | $99.72 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | G0511 | $66.26 | 1356307433 - BRUCE SCHULTZ | 274234147 - (IL) VOHRA WOUND PHYSICIANS OF IL SC | TX | Family Medicine Physician (207Q00000X) |
United | G0511 | $104.78 | 1811000177 - CHARLESTON RADIOLOGISTS PA | 570634747 - CHARLESTON RADIOLOGISTS, P.A. | SC | Single Specialty Group (193400000X) |
United | G0511 | $153.56 | 1366428401 - AARON ASKEW | 931224010 - PRAXIS HEALTH, P.C. | OR | Orthopaedic Trauma Physician (207XX0801X) |
United | G0511 | $97.09 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | G0511 | $83.12 | 1578983227 - LAURA NOS | 760459500 - U T PHYSICIANS | TX | Physician Assistant (363A00000X) |
United | G0511 | $49.35 | 1053866707 - BRITTANY PTACHICK | 541958039 - HROA 401K PLAN | VA | Family Nurse Practitioner (363LF0000X) |
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 G0511 vs. Other Other Services Codes
The HCPCS G0511 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 G0511 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 |
|---|---|---|
| G0509-HCPCS | Moderate | Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth |
| G0511-HCPCS | Low | Rural health clinic or federally qualified health center (RHC or FQHC) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an RHC or FQHC practitioner (physician, NP, PA, or CNM), per calendar month |
| G0512-HCPCS | Low | Rural health clinic or federally qualified health center (RHC or FQHC) only, psychiatric collaborative care model (psychiatric COCM), 60 minutes or more of clinical staff time for psychiatric cocm services directed by an RHC or FQHC practitioner (physician, NP, PA, or CNM) and including services furnished by a behavioral health care manager and consultation with a psychiatric consultant, per calendar month |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G0511. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G0511 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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