G0427

Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth

Medicare pricing data for 2,157 providers across 47 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

Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth (HCPCS code G0427) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $179.72, but hospitals typically charge $522.27 — a 2.9x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$35.94

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $179.72, your out-of-pocket cost would be approximately $35.94. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$179.72
Average Hospital Charge
$522.27
Markup Ratio
2.9x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$522.27
Medicare Allowed$179.72
Medicare Payment$141.14

Hospitals charge 2.9x more than what Medicare allows for this procedure. Medicare actually pays $141.14 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Connecticut$202$492935+12.2%
District of Columbia$199$535492+10.8%
Rhode Island$196$5163463+8.9%
New York$195$53380859+8.7%
New Jersey$195$59531322+8.4%
Hawaii$194$5996135+7.8%
California$193$7191141,305+7.3%
Maryland$191$45649451+6.5%
Illinois$189$54940685+5.2%
Massachusetts$189$60530194+5.0%
Oregon$186$59042422+3.5%
Florida$185$5172132,860+2.9%
Indiana$185$50441283+2.8%
Alabama$183$7975127+1.9%
Virginia$183$71040530+1.9%
Montana$183$489555+1.9%
Georgia$183$550691,344+1.8%
Colorado$183$59749240+1.8%
New Hampshire$181$843712+0.8%
Washington$180$52832332+0.0%
Wisconsin$180$65731344-0.0%
Kansas$179$856511-0.2%
Michigan$179$45187740-0.6%
Puerto Rico$178$603229-0.8%
Missouri$178$60575514-1.0%
South Dakota$177$22023671-1.4%
Oklahoma$177$371491,105-1.5%
Texas$177$4731983,587-1.7%
Idaho$177$514192-1.8%
Arizona$176$55529320-1.8%
Pennsylvania$176$5201831,239-1.9%
Minnesota$176$588104727-2.1%
Ohio$176$6331131,600-2.1%
New Mexico$175$35610217-2.6%
Nebraska$175$48426316-2.7%
North Dakota$175$5193109-2.8%
Kentucky$173$5016101-3.5%
North Carolina$173$52758756-3.5%
West Virginia$170$5701225-5.6%
South Carolina$168$61645478-6.4%
Utah$168$5118179-6.7%
Iowa$167$49316128-7.0%
Nevada$167$44311442-7.4%
Tennessee$166$445801,262-7.8%
Louisiana$165$41845603-8.1%
Arkansas$154$31816131-14.6%
Mississippi$144$437656-19.9%

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

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber