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See a sample rate comparisonHCPCS G4000 Fee Schedule
HCPCS G4000 is classified under Procedures / Professional Services, in the MIPS Specialty Set subgroup.
Dermatology mips specialty set
| Key Fact | Detail |
|---|---|
| Service Type | Procedures / Professional Services MIPS Specialty Set |
| Complexity Level | Low |
National average reimbursement for HCPCS G4000 by major payers:
$71.21
BCBS / Anthem
$N/A
UnitedHealthcare
$49.42
Aetna
$0.00
Cigna
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HCPCS G4000
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See a sample payer proposalHCPCS G4000 vs. Other MIPS Specialty Set Codes
The table lists codes related to G4000. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| G3003-HCPCS | Low | Chronic pain management and treatment, monthly bundle including, diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs, and desired outcomes; overall treatment management; facilitation and coordination of any necessary behavioral health treatment; medication management; pain and health literacy counseling; any necessary chronic pain related crisis care; and ongoing communication and care coordination between relevant practitioners furnishing care, e.g. physical therapy and occupational therapy, complementary and integrative approaches, and community-based care, as appropriate. required initial face-to-face visit at least 30 minutes provided by a physician or other qualified health professional; Each additional 15 minutes of chronic pain management and treatment by a physician or other qualified health care professional, per calendar month. (list separately in addition to code for g3002. when using g3003, 15 minutes must be met or exceeded.) |
| G4000-HCPCS | Low | Dermatology mips specialty set |
| G4001-HCPCS | Low | Diagnostic radiology mips specialty set |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G4000. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G4000 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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