HCPCS G0516 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 | Moderate |
National average reimbursement for HCPCS G0516 by major payers:
$245.30
$322.16
$222.14
$213.74
| 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 G0516 | ||||||
United | G0516 | $100.00 | 1255911970 - PINNACLE SURGERY CENTER | 842367400 - (LA) PINNACLE SURGERY CENTER | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | G0516 | $78.00 | 1659363844 - LASER & SURGERY CENTER OF ACADIANA | 721288671 - (LA) LASER SURGERY CENTER OF ACADIANA | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | G0516 | $100.00 | 1922178169 - IMPERIAL HEALTH, LLP | 721005645 - (LA) IMPERIAL HEALTH, LLP | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | G0516 | $566.00 | 1053453134 - ADVANCED SURGICAL CONCEPTS LLC | 331035210 - (LA) ADVANCED SURGICAL CONCEPTS LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | G0516 | $531.00 | 1053453134 - ADVANCED SURGICAL CONCEPTS LLC | 331035210 - (LA) ADVANCED SURGICAL CONCEPTS LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | G0516 | $113.00 | 1649921065 - JOINT REPLACEMENT CENTER OF LOUISIANA | 874022126 - (LA) JOINT REPLACEMENT CENTER OF LOUS | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | G0516 | $809.95 | 1326485749 - SOUTHERN REGIONAL MEDICAL CORPORATION, LEONARD J. CHABERT MEDICAL CENTER | 462743282 | LA | General Acute Care Hospital (282N00000X) |
United | G0516 | $203.00 | 1437482817 - ST MARTIN HOSPITAL, INC., ST MARTIN HOSPITAL | 264626264 - (LA) ST MARTIN HOSPITAL INC | LA | Critical Access Hospital (282NC0060X) |
United | G0516 | $100.00 | 1821250176 - NORTHSHORE AMBULATORY SURGERY CENTER LLC | 800352092 - (LA) NORTHSHORE AMBULATORY SURGERY CENTER LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | G0516 | $531.00 | 1104181247 - ADVANCED SURGERY CENTER OF NORTHERN LOUISIANA LLC | 455502071 - (LA) ADVANCED SURGERY CENTER OF NORTHERN LOUISIANA, LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | G0516 | $96.00 | 1598804486 - SHREVEPORT SURGERY CENTER PTRSHP | 721126552 - (LA) SHREVEPORT SURGERY CENTER OF CADDO PARISH, INC. | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | G0516 | $76.00 | 1831167329 - THIBODAUX ENDOSCOPY LLC | 810548522 - (LA) THIBODAUX ENDOSCOPY, L.L.C. | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | G0516 | $80.00 | 1972770022 - OUTPATIENT EYE SURGERY CENTER | 721098835 - (LA) OUTPATIENT EYE SURGERY CENTER | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | G0516 | $80.00 | 1801949631 - THIBODAUX SURGERY CENTER, LLC, BAYOU REGION SURGICAL CENTER | 320165642 - (LA) THIBODAUX SURGERY CENTER, LLC DBA BAYOU REGION SURGICAL CENTER | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | G0516 | $522.00 | 1144283292 - LAFAYETTE SURGERY CENTER LIMITED PARTNERSHIP | 943419282 - (LA) LAFAYETTE SURGERY CENTER LIMITED PARTNERSHIP | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
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 G0516 vs. Other Other Services Codes
The HCPCS G0516 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 G0516 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 |
|---|---|---|
| G0514-HCPCS | Low | Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (list separately in addition to code G0513 for additional 30 minutes of preventive service) |
| G0516-HCPCS | Moderate | Insertion of non-biodegradable drug delivery implants, 4 or more (services for subdermal rod implant) |
| G0517-HCPCS | Moderate | Removal of non-biodegradable drug delivery implants, 4 or more (services for subdermal implants) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G0516. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G0516 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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