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See a sample rate comparisonHCPCS G4036 Fee Schedule
HCPCS G4036 is classified under Procedures / Professional Services, in the MIPS Specialty Set subgroup.
Urgent care mips specialty set
| Key Fact | Detail |
|---|---|
| Service Type | Procedures / Professional Services MIPS Specialty Set |
| Complexity Level | Low |
National average reimbursement for HCPCS G4036 by major payers:
$68.35
BCBS / Anthem
$N/A
UnitedHealthcare
$49.42
Aetna
$0.00
Cigna
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HCPCS G4036
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Payer Contract Negotiation
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See a sample payer proposalHCPCS G4036 vs. Other MIPS Specialty Set Codes
The table lists codes related to G4036. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| G4035-HCPCS | Low | Thoracic surgery mips specialty set |
| G4036-HCPCS | Low | Urgent care mips specialty set |
| G4037-HCPCS | Low | Urology 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 G4036. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G4036 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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