Key facts for G0250
- Medicare payment
- $9.02
- PFS non-facility, national
- Coverage code
- D
- special coverage instructions apply
- Practitioner MUE
- 1
- MAI 2
- NCCI PTP pairs
- 137
- 122 hospital outpatient
- LCDs and articles
- 0 / 0
TL;DR
CMS describes HCPCS G0250, added in 2002, as "Physician review, interpretation, and patient management of home inr testing for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; testing not occurring more frequently than once a week; billing units of service include 4 tests". National PFS payment for G0250 is $9.02 in an office and no facility amount in a facility (October 2026), built from 0.18 work, 0.08 practice-expense and 0.01 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $9.06 at $33.5675. CMS caps G0250 at practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. In the NCCI PTP files v323r0 G0250 appears in 119 practitioner pairs as column 2 and 18 as column 1 (most often with 0591T, 0592T, 0593T), and in 112 hospital outpatient pairs as column 2 and 10 as column 1. No current LCD or billing article lists G0250; its HCPCS coverage code is D (special coverage instructions apply). OPPS status indicator M: Service not billable to the FI/MAC. HCPCS record: BETOS M1B (office visits - established); pricing indicator 11; type of service 1 (medical care). Nearby codes: G0249, G0248, G0247, G0246.
G0250 descriptor and code status
The October 2026 HCPCS Level II file describes G0250 as “Physician review, interpretation, and patient management of home inr testing for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; testing not occurring more frequently than once a week; billing units of service include 4 tests”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0250 CPT code", G0250 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.
| Field | Value |
|---|---|
| Short descriptor | Md inr test revie inter mgmt |
| Added to HCPCS | 2002-07-01 |
| Last action | N (no maintenance), effective 2008-03-19 |
| Coverage code | D: special coverage instructions apply |
| Pricing indicator | 11: physician fee schedule, priced with national RVUs |
| BETOS category | M1B: office visits - established |
| Type of service | 1: medical care |
Medicare payment for G0250
National PFS payment for G0250 is $9.02 in an office and no facility amount in a facility (October 2026), built from 0.18 work, 0.08 practice-expense and 0.01 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $9.06 at $33.5675. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.
Physician fee schedule (RVU26D)
Status R: restricted coverage: contractor-priced when covered. Global period XXX (global surgery concept does not apply); PC/TC indicator 2 (professional component only).
| Component | Non-facility | Facility |
|---|---|---|
| Work RVU | 0.18 | 0.18 |
| Practice expense RVU | 0.08 | NA |
| Malpractice RVU | 0.01 | 0.01 |
| Total RVUs | 0.27 | NA |
| National payment (CF $33.4009) | $9.02 | n/a |
| Qualifying APM participant (CF $33.5675) | $9.06 | n/a |
- Multiple procedures (modifier 51): no multiple-procedure reduction
- Bilateral (modifier 50): 150% bilateral adjustment does not apply
- Assistant at surgery: assistant at surgery paid only with documentation; co-surgeons: co-surgeons not permitted; team surgery: team surgeons not permitted
- Physician supervision of diagnostic procedures: supervision concept does not apply
Hospital outpatient (OPPS Addendum B)
Status indicator M (Service not billable to the FI/MAC), with no separate OPPS payment rate.
Medically Unlikely Edits for G0250
CMS caps G0250 at practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. The practitioner MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.
| Setting | MUE (units/DOS) | MAI | CMS rationale |
|---|---|---|---|
| Practitioner services | 1 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
| Facility outpatient hospital | 1 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
The MUE lookup for G0250 shows every setting next to any other code on the same claim.
NCCI edits and add-on rules
In the practitioner PTP file v323r0, G0250 is the column-2 (bundled) code in 119 active pairs, 71% of which allow a modifier and the column-1 code in 18 (22% modifier-allowed); 134 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Misuse of Column Two code with Column One code.
| Column-1 code | Pairs |
|---|---|
| 0591T (CPT; descriptor licensed by AMA) | 1 |
| 0592T (CPT; descriptor licensed by AMA) | 1 |
| 0593T (CPT; descriptor licensed by AMA) | 1 |
| 95251 (CPT; descriptor licensed by AMA) | 1 |
| 95717 (CPT; descriptor licensed by AMA) | 1 |
| 95718 (CPT; descriptor licensed by AMA) | 1 |
| 95719 (CPT; descriptor licensed by AMA) | 1 |
| 95720 (CPT; descriptor licensed by AMA) | 1 |
| Column-2 code | Pairs |
|---|---|
| 0578T (CPT; descriptor licensed by AMA) | 1 |
| 36591 (CPT; descriptor licensed by AMA) | 1 |
| 36592 (CPT; descriptor licensed by AMA) | 1 |
| 93294 (CPT; descriptor licensed by AMA) | 1 |
| 93295 (CPT; descriptor licensed by AMA) | 1 |
| 93297 (CPT; descriptor licensed by AMA) | 1 |
| 93298 (CPT; descriptor licensed by AMA) | 1 |
| 93793 (CPT; descriptor licensed by AMA) | 1 |
In the hospital outpatient PTP file v323r0, G0250 is the column-2 (bundled) code in 112 active pairs, 71% of which allow a modifier and the column-1 code in 10 (50% modifier-allowed); 109 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Misuse of Column Two code with Column One code.
| Column-1 code | Pairs |
|---|---|
| 0591T (CPT; descriptor licensed by AMA) | 1 |
| 0592T (CPT; descriptor licensed by AMA) | 1 |
| 0593T (CPT; descriptor licensed by AMA) | 1 |
| 95251 (CPT; descriptor licensed by AMA) | 1 |
| 95717 (CPT; descriptor licensed by AMA) | 1 |
| 95718 (CPT; descriptor licensed by AMA) | 1 |
| 95719 (CPT; descriptor licensed by AMA) | 1 |
| 95720 (CPT; descriptor licensed by AMA) | 1 |
| Column-2 code | Pairs |
|---|---|
| 0578T (CPT; descriptor licensed by AMA) | 1 |
| 93793 (CPT; descriptor licensed by AMA) | 1 |
| 98980 (CPT; descriptor licensed by AMA) | 1 |
| 99091 (CPT; descriptor licensed by AMA) | 1 |
| 99452 (CPT; descriptor licensed by AMA) | 1 |
| 99473 (CPT; descriptor licensed by AMA) | 1 |
| 99474 (CPT; descriptor licensed by AMA) | 1 |
| 99605 (CPT; descriptor licensed by AMA) | 1 |
G0250 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.
Pair counts show exposure, not the answer for one claim. Check G0250 against a second code to see whether the pair bundles and whether a modifier can separate the services.
Medicare coverage policies for G0250
No current LCD or billing and coding article lists G0250. The HCPCS coverage code D means special coverage instructions apply, and any National Coverage Determination for the service still applies.
Denials to expect on G0250
the modifier reported is inconsistent with the code
the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier
Where QuickIntell fits for G0250 claims
QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0250 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.
Frequently asked questions: HCPCS G0250
What does HCPCS code G0250 describe?
"Physician review, interpretation, and patient management of home inr testing for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; testing not occurring more frequently than once a week; billing units of service include 4 tests" (short descriptor "Md inr test revie inter mgmt"), in the G section (procedures and professional services, temporary). Added 2002-07-01; last action N (no maintenance) effective 2008-03-19.
Is G0250 a CPT code?
It is not. G0250 belongs to the G section (procedures and professional services, temporary) of HCPCS Level II, the CMS code set, not to AMA CPT. "G0250 CPT code" searches refer to it.
What does Medicare pay for G0250?
National PFS payment for G0250 is $9.02 in an office and no facility amount in a facility (October 2026), built from 0.18 work, 0.08 practice-expense and 0.01 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $9.06 at $33.5675.
How many units of G0250 can be billed per day?
CMS caps G0250 at practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. For the practitioner MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.
Does Medicare cover G0250?
No current LCD or billing article lists G0250; its HCPCS coverage code is D (special coverage instructions apply).
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.
- HCPCS Level II alpha-numeric file, October 2026Version October 2026 · effective 2026-10-01 · file HCPC2026_OCT_ANWEB_09232026.txtSHA-256 c25240c63108756d…
- Medicare PFS national relative value file RVU26D (non-QPP), October 2026Version RVU26D, released 2026-08-26 · effective 2026-10-01 · file PPRRVU2026_Oct_nonQPP.csvSHA-256 4d0d3f19bd954ffc…
- Medicare PFS national relative value file RVU26D (qualifying APM participants), October 2026Version RVU26D, released 2026-08-26 · effective 2026-10-01 · file PPRRVU2026_Oct_QPP.csvSHA-256 59d3734704853936…
- OPPS Addendum B, October 2026Version October 2026 · effective 2026-10-01 · file 508-compliant-version-2026_October_Web_Addendum_B.09.28.26.csvSHA-256 6ad7393a318bf1b9…
- Integrated Outpatient Code Editor v27.3 data tables: status and payment indicatorsVersion I/OCE v27.3 (October 2026) · effective 2026-10-01 · file Data_Status_Indicator.txtSHA-256 78f119ef0a435351…
- NCCI MUE table, practitioner services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_PractitionerServices_Eff_10-01-2026.csvSHA-256 ef038efaf902b7bd…
- NCCI MUE table, facility services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_OutpatientHospitalServices_Eff_10-01-2026.csvSHA-256 3af9f4e99cc587e2…
- NCCI MUE table, dme services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_DMESupplierServices_Eff_10-01-2026.csvSHA-256 6fa4fbba852f7b74…
- NCCI PTP edits, practitioner, v323r0 (four files)Version v323r0 (2026 Q4) · effective 2026-10-01 · file ccipra-v323r0-f1.TXTSHA-256 7793c0b6686c1e22…
- NCCI PTP edits, hospital outpatient, v323r0 (four files)Version v323r0 (2026 Q4) · effective 2026-10-01 · file ccioph-v323r0-f1.txtSHA-256 063f41b91ef9faa2…
Disclaimer
This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.
Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.