Medicare Reimbursement for G2011 – Alcohol/Substance Misuse Assessment

HCPCS code G2011 is used to report a brief screening and/or intervention service for alcohol or substance misuse. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount, both nationally and adjustable by locality, and how the amount differs when the service is furnished in a non-facility versus a facility setting.

Medicare allowed amount (2026)

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 1 unit per patient per day — Date of Service Edit: Policy. Units above the MUE are denied; some MUEs can be exceeded only with appropriate documentation and modifiers where policy allows.

How the amount is calculated

Medicare's PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — that reflect the relative resources needed to furnish the service. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual Conversion Factor to produce a dollar amount. Non-facility and facility payments differ mainly in the practice-expense RVU, since non-facility settings assume the practice bears more of the overhead costs (supplies, staff, equipment) compared to a facility setting. The resulting national or locality-specific figure represents the Medicare-allowed amount before any beneficiary cost-sharing is applied.

RVUs — work 0.33, practice expense 0.16 (non-facility) / 0.08 (facility), malpractice 0.03 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

• This is an estimate only, not a guarantee of payment.
• Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the patient or secondary payer may be responsible for the remainder.
• Actual payment can vary by locality-specific GPCIs, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments.
• Always verify the current allowed amount and any billing requirements with your Medicare Administrative Contractor (MAC).

Frequently asked

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Estimated Medicare Physician Fee Schedule amount. Medicare generally pays 80% after the deductible; actual amounts vary by locality, modifiers, sequestration, and annual updates. Verify with your MAC.