What is the standard insurance baseline for HCPCS G0397?

The standard insurance baseline reimbursement rate is $65.39. This represents the customary allowable amount established across standard fee schedules.

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HCPCS G0397Medical Service

Alcohol and or Substance Other Than Tobacco Misuse Structured Assessment E G

Q: What do doctors typically charge for Alcohol and or Substance Other Than Tobacco Misuse Structured Assessment E G?

The nationwide median physician charge for Alcohol and or Substance Other Than Tobacco Misuse Structured Assessment E G (HCPCS G0397) is $125.60. Doctor billed charges vary based on geographic region, setting, and overhead.

Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes. Clinical pricing breakdown and utilization metrics across 26 practicing doctors nationwide.

$125.60

Peer Median Charge

Gross billed rate

$65.39

Standard Baseline

Customary allowable

1.9x

National Markup

Charge vs baseline

Active Physicians

Billing this code

Planning care or already received a bill for CPT G0397?Calculate total facility bundle costs or generate an assertive dispute settlement offer.

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Understanding This Medical Fee

Gross Charge vs Negotiated Payment: The median physician charge for this service is $125.60. However, insured patients almost never pay this full amount directly. Insurers negotiate rates down toward the $65.39 baseline.

Self-Pay & Uninsured Guidance: If you are paying without insurance or out-of-network, request a prompt-pay cash discount. Most medical practices are willing to settle self-pay bills near the customary baseline rate rather than the full gross charge.

Key Questions for Your Doctor's Billing Office:

"Does Dr. [Name] participate in my specific insurance plan network?"
"What is the total self-pay or cash rate for code G0397 if paid upfront?"
"Are there separate facility, anesthesia, or pathology fees associated with this procedure?"