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HCPCS G0381 · Level II · G code

G0381: Level 2 hospital emergency department visit provided in a type b emergency department, 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 G0381

Medicare payment
$94.90
OPPS rate, SI J2
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Facility outpatient MUE
2
MAI 3
OPPS status
SI J2
Hospital Part B services that may be paid through a comprehensive APC
NCCI PTP pairs
472
467 hospital outpatient
LCDs and articles
0 / 0

TL;DR

G0381 is a Level II code from the G section (procedures and professional services, temporary), in use since 2007: "Level 2 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)". Hospital outpatient departments are paid $94.90 for G0381 under status indicator J2, APC 5032 (Level 2 Type B ED Visits), minimum unadjusted copayment $18.98 (October 2026 Addendum B). MUE limits for G0381: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 3, Clinical: Data). In the NCCI PTP files v323r0 G0381 appears in 398 practitioner pairs as column 2 and 74 as column 1 (most often with 00100, 00102, 00103), and in 395 hospital outpatient pairs as column 2 and 72 as column 1. G0381 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code C (carrier judgment, so the Medicare contractor decides coverage) and any NCD. HCPCS record: BETOS M3 (emergency room visit); pricing indicator 00; type of service 1 (medical care). Nearby codes: G0380, G0382, G0379, G0383.

G0381 descriptor and code status

The October 2026 HCPCS Level II file describes G0381 as “Level 2 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes.

HCPCS file attributes of G0381
FieldValue
Short descriptorLev 2 hosp type b ed visit
Added to HCPCS2007-01-01
Last actionN (no maintenance), effective 2008-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator00: not separately priced by Part B
BETOS categoryM3: emergency room visit
Type of service1: medical care

Medicare payment for G0381

Hospital outpatient departments are paid $94.90 for G0381 under status indicator J2, APC 5032 (Level 2 Type B ED Visits), minimum unadjusted copayment $18.98 (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 X: statutory exclusion: not a physician service under the fee schedule. 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 J2 (Hospital Part B services that may be paid through a comprehensive APC), APC 5032 (Level 2 Type B ED Visits), national unadjusted payment $94.90 with a minimum unadjusted copayment of $18.98.

Medically Unlikely Edits for G0381

MUE limits for G0381: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 3, Clinical: Data). 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 G0381 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital23 Date of Service Edit: ClinicalClinical: Data

The MUE lookup for G0381 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, G0381 is the column-2 (bundled) code in 398 active pairs, 96% of which allow a modifier and the column-1 code in 74 (81% modifier-allowed); 157 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Standard preparation/monitoring services for anesthesia.

Column-1 codes most often paired with G0381 (practitioner)
Column-1 codePairs
00100 (CPT; descriptor licensed by AMA)1
00102 (CPT; descriptor licensed by AMA)1
00103 (CPT; descriptor licensed by AMA)1
00104 (CPT; descriptor licensed by AMA)1
00120 (CPT; descriptor licensed by AMA)1
00124 (CPT; descriptor licensed by AMA)1
00126 (CPT; descriptor licensed by AMA)1
00140 (CPT; descriptor licensed by AMA)1
Column-2 codes bundled into G0381 (practitioner)
Column-2 codePairs
0708T (CPT; descriptor licensed by AMA)1
0709T (CPT; descriptor licensed by AMA)1
36591 (CPT; descriptor licensed by AMA)1
36592 (CPT; descriptor licensed by AMA)1
43752 (CPT; descriptor licensed by AMA)1
90839 (CPT; descriptor licensed by AMA)1
90840 (CPT; descriptor licensed by AMA)1
90940 (CPT; descriptor licensed by AMA)1

In the hospital outpatient PTP file v323r0, G0381 is the column-2 (bundled) code in 395 active pairs, 98% of which allow a modifier and the column-1 code in 72 (96% modifier-allowed); 157 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Standard preparation/monitoring services for anesthesia.

Column-1 codes most often paired with G0381 (hospital outpatient)
Column-1 codePairs
00100 (CPT; descriptor licensed by AMA)1
00102 (CPT; descriptor licensed by AMA)1
00103 (CPT; descriptor licensed by AMA)1
00104 (CPT; descriptor licensed by AMA)1
00120 (CPT; descriptor licensed by AMA)1
00124 (CPT; descriptor licensed by AMA)1
00126 (CPT; descriptor licensed by AMA)1
00140 (CPT; descriptor licensed by AMA)1
Column-2 codes bundled into G0381 (hospital outpatient)
Column-2 codePairs
0591T (CPT; descriptor licensed by AMA)1
0592T (CPT; descriptor licensed by AMA)1
0593T (CPT; descriptor licensed by AMA)1
0708T (CPT; descriptor licensed by AMA)1
0709T (CPT; descriptor licensed by AMA)1
43752 (CPT; descriptor licensed by AMA)1
90839 (CPT; descriptor licensed by AMA)1
90840 (CPT; descriptor licensed by AMA)1

G0381 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 G0381 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0381

No current LCD or billing and coding article lists G0381. The HCPCS coverage code C means carrier judgment, so the Medicare contractor decides coverage, and any National Coverage Determination for the service still applies.

Denials to expect on G0381

CARC 50 · N115

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

CARC 151 · N362

units of G0381 exceed the facility outpatient MUE of 2 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 G0381 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0381 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 G0381

What does HCPCS code G0381 describe?

"Level 2 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)" (short descriptor "Lev 2 hosp type b ed visit"), in the G section (procedures and professional services, temporary). Added 2007-01-01; last action N (no maintenance) effective 2008-01-01.

Is G0381 a CPT code?

No: CMS maintains G0381 in HCPCS Level II, while the AMA maintains CPT. It goes in the same procedure-code field.

What does Medicare pay for G0381?

Hospital outpatient departments are paid $94.90 for G0381 under status indicator J2, APC 5032 (Level 2 Type B ED Visits), minimum unadjusted copayment $18.98 (October 2026 Addendum B).

How many units of G0381 can be billed per day?

MUE limits for G0381: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 3, Clinical: Data). For the facility outpatient MUE (MAI 3), units above 2 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover G0381?

G0381 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code C (carrier judgment, so the Medicare contractor decides coverage) 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.