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HCPCS G0257 · Level II · G code

G0257: Unsched dialysis ESRD pt hos, HCPCS Level II G code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file.

Key facts for G0257

Medicare payment
$701.18
OPPS rate, SI S
Coverage code
D
special coverage instructions apply
Facility outpatient MUE
1
MAI 3
OPPS status
SI S
Procedure or service, not discounted when multiple
NCCI PTP pairs
28
31 hospital outpatient
LCDs and articles
0 / 0

TL;DR

G0257 is a Level II code from the G section (procedures and professional services, temporary), in use since 2003: "Unscheduled or emergency dialysis treatment for an esrd patient in a hospital outpatient department that is not certified as an esrd facility". Hospital outpatient departments are paid $701.18 for G0257 under status indicator S, APC 5401 (Dialysis), minimum unadjusted copayment $140.24 (October 2026 Addendum B). Its 2026 Q4 MUEs per date of service: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 1 (MAI 3, Nature of Service/Procedure). In the NCCI PTP files v323r0 G0257 appears in 0 practitioner pairs as column 2 and 28 as column 1, and in 0 hospital outpatient pairs as column 2 and 31 as column 1. G0257 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code D (special coverage instructions apply) and any NCD. HCPCS record: BETOS P6D (minor procedures - other (non-Medicare fee schedule)); pricing indicator 00; type of service 1 (medical care). Nearby codes: G0260, G0250, G0249, G0248.

G0257 descriptor and code status

The October 2026 HCPCS Level II file describes G0257 as “Unscheduled or emergency dialysis treatment for an esrd patient in a hospital outpatient department that is not certified as an esrd facility”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0257 CPT code", G0257 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.

HCPCS file attributes of G0257
FieldValue
Short descriptorUnsched dialysis esrd pt hos
Added to HCPCS2003-01-01
Last actionN (no maintenance), effective 2003-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator00: not separately priced by Part B
BETOS categoryP6D: minor procedures - other (non-Medicare fee schedule)
Type of service1: medical care

Medicare payment for G0257

Hospital outpatient departments are paid $701.18 for G0257 under status indicator S, APC 5401 (Dialysis), minimum unadjusted copayment $140.24 (October 2026 Addendum B). 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 E: excluded from the physician fee schedule by regulation. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).

Hospital outpatient (OPPS Addendum B)

Status indicator S (Procedure or service, not discounted when multiple), APC 5401 (Dialysis), national unadjusted payment $701.18 with a minimum unadjusted copayment of $140.24.

Medically Unlikely Edits for G0257

Its 2026 Q4 MUEs per date of service: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 1 (MAI 3, Nature of Service/Procedure). The facility outpatient MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for G0257 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital13 Date of Service Edit: ClinicalNature of Service/Procedure

The MUE lookup for G0257 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, G0257 is the column-2 (bundled) code in 0 active pairs and the column-1 code in 28 (89% modifier-allowed); 12 earlier pairs have been deleted.

Column-2 codes bundled into G0257 (practitioner)
Column-2 codePairs
0407U (CPT; descriptor licensed by AMA)1
36000 (CPT; descriptor licensed by AMA)1
36410 (CPT; descriptor licensed by AMA)1
36430 (CPT; descriptor licensed by AMA)1
36591 (CPT; descriptor licensed by AMA)1
36592 (CPT; descriptor licensed by AMA)1
36901 (CPT; descriptor licensed by AMA)1
36902 (CPT; descriptor licensed by AMA)1

In the hospital outpatient PTP file v323r0, G0257 is the column-2 (bundled) code in 0 active pairs and the column-1 code in 31 (100% modifier-allowed); 8 earlier pairs have been deleted.

Column-2 codes bundled into G0257 (hospital outpatient)
Column-2 codePairs
0407U (CPT; descriptor licensed by AMA)1
0708T (CPT; descriptor licensed by AMA)1
0709T (CPT; descriptor licensed by AMA)1
36000 (CPT; descriptor licensed by AMA)1
36410 (CPT; descriptor licensed by AMA)1
36430 (CPT; descriptor licensed by AMA)1
36901 (CPT; descriptor licensed by AMA)1
36902 (CPT; descriptor licensed by AMA)1

G0257 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 G0257 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0257

No current LCD or billing and coding article lists G0257. The HCPCS coverage code D means special coverage instructions apply, and any National Coverage Determination for the service still applies.

Denials to expect on G0257

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units of G0257 exceed the facility outpatient MUE of 1 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for G0257 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0257 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS G0257

What does HCPCS code G0257 describe?

"Unscheduled or emergency dialysis treatment for an esrd patient in a hospital outpatient department that is not certified as an esrd facility" (short descriptor "Unsched dialysis esrd pt hos"), in the G section (procedures and professional services, temporary). Added 2003-01-01.

Is G0257 a CPT code?

No. G0257 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set. Searches for "G0257 CPT code" mean this Level II code.

What does Medicare pay for G0257?

Hospital outpatient departments are paid $701.18 for G0257 under status indicator S, APC 5401 (Dialysis), minimum unadjusted copayment $140.24 (October 2026 Addendum B).

How many units of G0257 can be billed per day?

Its 2026 Q4 MUEs per date of service: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 1 (MAI 3, Nature of Service/Procedure). For the facility outpatient MUE (MAI 3), units above 1 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover G0257?

G0257 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code D (special coverage instructions apply) and any NCD.

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.

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.