HCPCS G0438: what Medicare pays in 2026
Service defined by CMS CMS description: Ppps, initial visit
Medicare's 2026 national amount for G0438 is $174.35 when a doctor's office or clinic bills it. Across Medicare's 109 payment localities the office amount runs from $160.06 in Arkansas to $220.54 in Alaska.
Medicare amounts for G0438 in 2026
- Doctor's office or clinic, national
- $174.35
- Hospital outpatient status A
- paid from a different Medicare fee schedule, not the outpatient system
What providers charged Medicare for G0438 in 2024
From CMS's national utilization file (the most recent full year published). The charge is the provider's list price, the same kind of figure an uninsured patient is usually billed.
| Setting | Services | Average charge | Medicare allowed | Charge vs allowed |
|---|---|---|---|---|
| In an office or other non-facility setting | 653,792 | $369.83 | $150.17 | 2.5× |
| In a facility setting | 23,092 | $387.05 | $145.06 | 2.7× |
How Medicare builds the G0438 amount
Each physician fee schedule amount is three relative value units (RVUs), each multiplied by the locality's cost index, added up and multiplied by the 2026 conversion factor of $33.4009.
- Work RVU
- 2.60
- Practice expense RVU, office
- 2.45
- Malpractice RVU
- 0.17
G0438 in every Medicare locality
The office amount is lowest in Arkansas and highest in Alaska.