Prolonged Hospital Inpatient Or Observation Care Evaluation And Management Service(s) Beyond The Total Time For The Primary Service (when The Primary Service Has Been Selected Using Time On The Date Of The Primary Service); Each Additional 15 Minutes By Th
What Medicare pays for G0316, what providers bill, and how the price varies across 52 states, drawn from CMS 2023 claims data.
G0316 · the short answer
For prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by th, Medicare pays about $23.22 while providers bill $106.65 on average, a 4.6× markup, a below-median markup. State-level Medicare rates range 41% from lowest to highest.
- Medicare pays
- $23.22
- Providers bill
- $106.65
- Markup
- 4.6×
- Markup percentile
- 30th
Medicare amounts are CMS-published; markup = average submitted charge ÷ average Medicare payment.
Price Range Across States
What You Might Pay
Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
How we estimate these prices
These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Temporary Procedures procedures average 2.24x Medicare rates. Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.
Where this markup sits nationally
Markup (billed ÷ Medicare) across 8,901 procedures with a meaningful Medicare rate
5 more affordable than 30% of 8,901 procedures
Each bar is a band; taller bars hold more procedures. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.
Source CMS Medicare Physician & Other Practitioners · 2023
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| Alaska | $29.33 | $83.87 |
| District of Columbia | $26.36 | $97.27 |
| California | $25.38 | $129.20 |
| Puerto Rico | $25.19 | $82.17 |
| New Jersey | $25.00 | $94.65 |
| Nevada | $24.84 | $130.74 |
| Hawaii | $24.59 | $82.92 |
| Maryland | $24.49 | $92.61 |
| Illinois | $24.27 | $102.95 |
| Washington | $24.08 | $90.17 |
| Oregon | $23.87 | $96.69 |
| New York | $23.80 | $164.30 |
| Connecticut | $23.80 | $114.71 |
| Virginia | $23.66 | $84.11 |
| Texas | $23.27 | $161.18 |
| Georgia | $23.21 | $89.87 |
| Massachusetts | $23.18 | $108.31 |
| Montana | $23.11 | $85.01 |
| Colorado | $23.07 | $83.28 |
| Vermont | $23.07 | $106.51 |
| Delaware | $22.94 | $146.39 |
| Florida | $22.83 | $85.88 |
| New Hampshire | $22.83 | $145.96 |
| New Mexico | $22.75 | $89.33 |
| Pennsylvania | $22.72 | $78.88 |
| Wyoming | $22.62 | $87.44 |
| Maine | $22.58 | $107.75 |
| Missouri | $22.56 | $103.91 |
| Alabama | $22.54 | $74.63 |
| Tennessee | $22.52 | $106.76 |
| Arizona | $22.51 | $83.29 |
| Kansas | $22.49 | $77.47 |
| Oklahoma | $22.35 | $87.16 |
| Ohio | $22.31 | $95.96 |
| Michigan | $22.26 | $82.30 |
| Minnesota | $22.23 | $96.04 |
| North Dakota | $22.16 | $93.08 |
| Iowa | $21.97 | $87.98 |
| Arkansas | $21.96 | $96.25 |
| Kentucky | $21.95 | $79.62 |
| South Dakota | $21.93 | $71.81 |
| West Virginia | $21.60 | $192.07 |
| South Carolina | $21.60 | $82.14 |
| Mississippi | $21.53 | $140.90 |
| Utah | $21.45 | $84.14 |
| Louisiana | $21.45 | $91.59 |
| Idaho | $21.40 | $49.88 |
| Rhode Island | $21.31 | $44.45 |
| Indiana | $21.28 | $85.00 |
| Nebraska | $21.16 | $80.19 |
| North Carolina | $20.99 | $113.33 |
| Wisconsin | $20.85 | $131.16 |
What the Data Says About Prolonged Hospital Inpatient Or Observation Care Evaluation And Management Service(s) Beyond The Total Time For The Primary Service (when The Primary Service Has Been Selected Using Time On The Date Of The Primary Service); Each Additional 15 Minutes By Th
Across 52 states with reporting providers, CPT code G0316 (Prolonged Hospital Inpatient Or Observation Care Evaluation And Management Service(s) Beyond The Total Time For The Primary Service (when The Primary Service Has Been Selected Using Time On The Date Of The Primary Service); Each Additional 15 Minutes By Th) shows a national average Medicare payment of $23.22 against an average billed charge of $106.65. That gap, a 4.6x markup, or 359% above the Medicare allowed amount, is narrower than most procedures in our dataset, suggesting providers price this code closer to what payers actually reimburse.
Temporary Procedures procedures like this one saw 360.2K services billed to Medicare in 2023 by 21.2K distinct providers, serving 127.5K unique beneficiaries. State-level variation is significant: Wisconsin reports the lowest average payment at $20.85, while Alaska reports the highest at $29.33. The 41% spread here is a moderate, fairly ordinary GPCI effect, local cost-of-practice adjustments nudging the allowed amount up or down without reshaping it.
Applying RAND 2024 commercial-to-Medicare ratios specific to the Temporary Procedures category (2.24x), the estimated commercial insurance price lands near $65.29, with self-pay cash discounts commonly bringing the figure closer to $51.19. Within Temporary Procedures, Prolonged Hospital Inpatient Or Observation Care Evaluation And Management Service(s) Beyond The Total Time For The Primary Service (when The Primary Service Has Been Selected Using Time On The Date Of The Primary Service); Each Additional 15 Minutes By Th ranks #139 of 172 tracked procedures by national average Medicare payment.
What to do with this
If you may have prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by th done, these steps turn the numbers above into a real-world cost estimate.
- Request a Good Faith Estimate from your provider at least 3 business days before a scheduled procedure, under the No Surprises Act it is an enforceable written price.
- Compare prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by th costs in your state, Medicare rates vary by locality. Browse states
- Check a hospital’s published cash price, which is often far below the billed charge. Price transparency
- Understand why billed charges run several times the Medicare rate before you negotiate. Read the guide
Figures here are averages and estimates, not a quote. Confirm coverage and out-of-pocket costs with your insurer and provider.
Frequently Asked Questions
How much does Prolonged Hospital Inpatient Or Observation Care Evaluation And Management Service(s) Beyond The Total Time For The Primary Service (when The Primary Service Has Been Selected Using Time On The Date Of The Primary Service); Each Additional 15 Minutes By Th cost?
Medicare's national average payment for Prolonged Hospital Inpatient Or Observation Care Evaluation And Management Service(s) Beyond The Total Time For The Primary Service (when The Primary Service Has Been Selected Using Time On The Date Of The Primary Service); Each Additional 15 Minutes By Th (CPT G0316) is $23.22, with providers billing $106.65 on average; state rates run from $20.85 to $29.33, a meaningful but not extreme spread.
Why do providers charge more than Medicare pays?
Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.
How much does Prolonged Hospital Inpatient Or Observation Care Evaluation And Management Service(s) Beyond The Total Time For The Primary Service (when The Primary Service Has Been Selected Using Time On The Date Of The Primary Service); Each Additional 15 Minutes By Th cost with insurance?
With commercial insurance, prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by th costs an estimated $65.29 on average (range: $45.70-$91.41), a moderate premium over Medicare's $23.22. Without insurance, the estimated cash price is $51.19.
Which state has the lowest cost for Prolonged Hospital Inpatient Or Observation Care Evaluation And Management Service(s) Beyond The Total Time For The Primary Service (when The Primary Service Has Been Selected Using Time On The Date Of The Primary Service); Each Additional 15 Minutes By Th?
Wisconsin has the lowest average Medicare payment for Prolonged Hospital Inpatient Or Observation Care Evaluation And Management Service(s) Beyond The Total Time For The Primary Service (when The Primary Service Has Been Selected Using Time On The Date Of The Primary Service); Each Additional 15 Minutes By Th at $20.85, while Alaska has the highest at $29.33 - a meaningful $8.48 spread.
How many providers perform Prolonged Hospital Inpatient Or Observation Care Evaluation And Management Service(s) Beyond The Total Time For The Primary Service (when The Primary Service Has Been Selected Using Time On The Date Of The Primary Service); Each Additional 15 Minutes By Th?
Prolonged Hospital Inpatient Or Observation Care Evaluation And Management Service(s) Beyond The Total Time For The Primary Service (when The Primary Service Has Been Selected Using Time On The Date Of The Primary Service); Each Additional 15 Minutes By Th is a widely-performed procedure: 21.2K providers billed Medicare for it in 2023 across 52 states, together handling 360.2K services for 127.5K beneficiaries.
What is the billed-to-Medicare markup for Prolonged Hospital Inpatient Or Observation Care Evaluation And Management Service(s) Beyond The Total Time For The Primary Service (when The Primary Service Has Been Selected Using Time On The Date Of The Primary Service); Each Additional 15 Minutes By Th?
Providers bill 4.6x what Medicare pays for Prolonged Hospital Inpatient Or Observation Care Evaluation And Management Service(s) Beyond The Total Time For The Primary Service (when The Primary Service Has Been Selected Using Time On The Date Of The Primary Service); Each Additional 15 Minutes By Th - a below-median markup at 359% above the Medicare rate.
Related Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error.