Comprehensive Assessment Of And Care Planning For Patients Requiring Chronic Care Management Services (list Separately In Addition To Primary Monthly Care Management Service)
What Medicare pays for G0506, what providers bill, and how the price varies across 49 states, drawn from CMS 2023 claims data.
G0506 · the short answer
For comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service), Medicare pays about $40.00 while providers bill $113.42 on average, a 2.8× markup, one of the smaller markups in the catalog. State-level Medicare rates range 57% from lowest to highest.
- Medicare pays
- $40.00
- Providers bill
- $113.42
- Markup
- 2.8×
- Markup percentile
- 9th
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
3 more affordable than 9% 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 |
|---|---|---|
| District of Columbia | $50.09 | $105.96 |
| California | $48.80 | $128.35 |
| Alaska | $47.81 | $177.45 |
| Hawaii | $47.06 | $88.63 |
| Connecticut | $45.19 | $200.89 |
| New Jersey | $45.06 | $109.10 |
| South Dakota | $44.39 | $126.64 |
| Maryland | $44.15 | $93.41 |
| Montana | $43.66 | $102.39 |
| New Hampshire | $43.36 | $106.55 |
| Colorado | $43.22 | $97.97 |
| Delaware | $42.68 | $86.32 |
| Minnesota | $42.46 | $119.82 |
| Michigan | $42.17 | $116.39 |
| Louisiana | $41.68 | $134.87 |
| Florida | $41.38 | $117.92 |
| Arkansas | $40.96 | $113.96 |
| Massachusetts | $40.84 | $118.04 |
| Mississippi | $40.57 | $97.35 |
| Arizona | $40.56 | $150.21 |
| Nevada | $40.07 | $94.08 |
| Kentucky | $39.78 | $96.12 |
| Alabama | $39.73 | $93.90 |
| Illinois | $39.72 | $116.72 |
| Ohio | $39.64 | $109.35 |
| Texas | $39.50 | $103.85 |
| North Dakota | $39.31 | $124.96 |
| Maine | $38.77 | $96.54 |
| Guam | $38.17 | $92.34 |
| Utah | $38.15 | $115.54 |
| North Carolina | $38.03 | $116.11 |
| New York | $37.93 | $113.92 |
| South Carolina | $37.82 | $88.38 |
| Virginia | $37.55 | $107.73 |
| Indiana | $37.13 | $105.07 |
| Kansas | $37.04 | $76.37 |
| Georgia | $36.83 | $104.06 |
| New Mexico | $36.71 | $120.31 |
| Washington | $36.65 | $118.00 |
| Wisconsin | $36.44 | $121.06 |
| Idaho | $36.32 | $104.51 |
| Oklahoma | $36.11 | $89.39 |
| Nebraska | $35.67 | $160.40 |
| Pennsylvania | $35.34 | $102.32 |
| Iowa | $34.17 | $116.70 |
| Oregon | $33.95 | $92.25 |
| Tennessee | $33.68 | $111.52 |
| West Virginia | $33.66 | $93.20 |
| Missouri | $31.84 | $78.20 |
What the Data Says About Comprehensive Assessment Of And Care Planning For Patients Requiring Chronic Care Management Services (list Separately In Addition To Primary Monthly Care Management Service)
Across 49 states with reporting providers, CPT code G0506 (Comprehensive Assessment Of And Care Planning For Patients Requiring Chronic Care Management Services (list Separately In Addition To Primary Monthly Care Management Service)) shows a national average Medicare payment of $40.00 against an average billed charge of $113.42. That gap, a 2.8x markup, or 184% above the Medicare allowed amount, is among the tightest billed-to-paid spreads we track, this code's chargemaster rate tracks unusually close to the Medicare benchmark.
Temporary Procedures procedures like this one saw 148.1K services billed to Medicare in 2023 by 4.8K distinct providers, serving 134.2K unique beneficiaries. State-level variation is significant: Missouri reports the lowest average payment at $31.84, while District of Columbia reports the highest at $50.09. A 57% spread this wide is typically a GPCI story: practice-expense and malpractice-premium components of the fee formula diverge sharply by locality even though the procedure code never changes.
Applying RAND 2024 commercial-to-Medicare ratios specific to the Temporary Procedures category (2.24x), the estimated commercial insurance price lands near $117.78, with self-pay cash discounts commonly bringing the figure closer to $70.62. Within Temporary Procedures, Comprehensive Assessment Of And Care Planning For Patients Requiring Chronic Care Management Services (list Separately In Addition To Primary Monthly Care Management Service) ranks #99 of 172 tracked procedures by national average Medicare payment.
What to do with this
If you may have comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service) 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 comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service) 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 Comprehensive Assessment Of And Care Planning For Patients Requiring Chronic Care Management Services (list Separately In Addition To Primary Monthly Care Management Service) cost?
Medicare's national average payment for Comprehensive Assessment Of And Care Planning For Patients Requiring Chronic Care Management Services (list Separately In Addition To Primary Monthly Care Management Service) (CPT G0506) is $40.00, with providers billing $113.42 on average; state rates run from $31.84 to $50.09, 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 Comprehensive Assessment Of And Care Planning For Patients Requiring Chronic Care Management Services (list Separately In Addition To Primary Monthly Care Management Service) cost with insurance?
With commercial insurance, comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service) costs an estimated $117.78 on average (range: $82.44-$164.89), a moderate premium over Medicare's $40.00. Without insurance, the estimated cash price is $70.62.
Which state has the lowest cost for Comprehensive Assessment Of And Care Planning For Patients Requiring Chronic Care Management Services (list Separately In Addition To Primary Monthly Care Management Service)?
Missouri has the lowest average Medicare payment for Comprehensive Assessment Of And Care Planning For Patients Requiring Chronic Care Management Services (list Separately In Addition To Primary Monthly Care Management Service) at $31.84, while District of Columbia has the highest at $50.09 - a meaningful $18.25 spread.
How many providers perform Comprehensive Assessment Of And Care Planning For Patients Requiring Chronic Care Management Services (list Separately In Addition To Primary Monthly Care Management Service)?
A moderate provider base performs Comprehensive Assessment Of And Care Planning For Patients Requiring Chronic Care Management Services (list Separately In Addition To Primary Monthly Care Management Service): 4.8K providers nationally, totaling 148.1K Medicare-billed services (134.2K beneficiaries) across 49 states in 2023.
What is the billed-to-Medicare markup for Comprehensive Assessment Of And Care Planning For Patients Requiring Chronic Care Management Services (list Separately In Addition To Primary Monthly Care Management Service)?
Providers bill 2.8x what Medicare pays for Comprehensive Assessment Of And Care Planning For Patients Requiring Chronic Care Management Services (list Separately In Addition To Primary Monthly Care Management Service) - one of the smaller markups in the catalog at 184% 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.