G0396

Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes

Medicare pricing data for 1,309 providers across 39 states

🤖AI Overview

Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes (HCPCS code G0396) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $33.21, but hospitals typically charge $83.52 — a 2.5x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$6.64

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $33.21, your out-of-pocket cost would be approximately $6.64. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$33.21
Average Hospital Charge
$83.52
Markup Ratio
2.5x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$83.52
Medicare Allowed$33.21
Medicare Payment$24.65

Hospitals charge 2.5x more than what Medicare allows for this procedure. Medicare actually pays $24.65 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$45$509228+34.2%
District of Columbia$38$57411+12.9%
Washington$37$8792,950+12.3%
Maryland$37$58782,623+11.3%
Virginia$37$5613510+10.5%
New Jersey$36$9426629+9.8%
Utah$35$896130+5.9%
New York$35$831452,736+5.5%
California$35$891155,715+4.5%
New Hampshire$34$1285433+3.5%
Nevada$34$147191,278+3.0%
Texas$33$1001389,253+0.7%
Florida$33$801224,375+0.5%
Illinois$33$6923104+0.4%
Missouri$33$16416570+0.3%
Massachusetts$33$6223964+0.1%
Idaho$33$44322-0.4%
Michigan$33$6435980-1.2%
South Carolina$33$10410444-1.7%
New Mexico$33$4810108-1.8%
Connecticut$33$7116312-2.0%
Alabama$32$54221,598-2.3%
Pennsylvania$32$85281,464-2.3%
Oklahoma$32$8910719-2.6%
Nebraska$32$50771-3.9%
Georgia$32$61271,124-4.7%
North Carolina$31$10428956-5.2%
Delaware$31$5591,089-5.5%
Oregon$31$5125304-6.3%
Minnesota$31$9520488-7.1%
Louisiana$31$541449-7.8%
Colorado$30$6215168-10.1%
Mississippi$30$56712-10.2%
Arizona$30$94501,003-10.9%
Indiana$29$5547598-12.6%
Tennessee$29$68695,662-13.3%
Kentucky$29$6040483-13.5%
Arkansas$28$60875-16.7%
Ohio$26$711686-21.7%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

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