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HCPCS G0421 · Level II · G code

G0421: Face-to-face educational services related to the care of chronic kidney disease; group, 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 G0421

Medicare payment
$27.39
PFS non-facility, national
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
2
MAI 3
OPPS status
SI A
Services not paid under OPPS; paid under fee schedule or other payment system
NCCI PTP pairs
5
2 hospital outpatient
LCDs and articles
0 / 0
on the Medicare telehealth list

TL;DR

CMS describes HCPCS G0421, added in 2010, as "Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour". National PFS payment for G0421 is $27.39 in an office and no facility amount in a facility (October 2026), built from 0.50 work, 0.29 practice-expense and 0.03 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $27.53 at $33.5675. CMS caps G0421 at practitioner 2 (MAI 3, Clinical: Data); hospital outpatient 2 (MAI 3, Clinical: Data) units per day in the 2026 Q4 MUE tables. In the NCCI PTP files v323r0 G0421 appears in 1 practitioner pairs as column 2 and 4 as column 1 (most often with G0420), and in 1 hospital outpatient pairs as column 2 and 1 as column 1. No current LCD or billing article lists G0421; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage). It is on the CY2026 Medicare telehealth list (CMS action: Maintain). OPPS status indicator A: Services not paid under OPPS; paid under fee schedule or other payment system. HCPCS record: BETOS M1B (office visits - established); pricing indicator 11; type of service 1 (medical care). 1 other active code opens with "Face-to-face educational services related to the care of chronic kidney disease"; related codes: G0420, G0422, G0423, G0425.

G0421 descriptor and code status

The October 2026 HCPCS Level II file describes G0421 as “Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes.

HCPCS file attributes of G0421
FieldValue
Short descriptorEd svc ckd grp per session
Added to HCPCS2010-01-01
Last actionN (no maintenance), effective 2010-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator11: physician fee schedule, priced with national RVUs
BETOS categoryM1B: office visits - established
Type of service1: medical care

Medicare payment for G0421

National PFS payment for G0421 is $27.39 in an office and no facility amount in a facility (October 2026), built from 0.50 work, 0.29 practice-expense and 0.03 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $27.53 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 A: active: paid separately under the physician fee schedule when covered. Global period XXX (global surgery concept does not apply); PC/TC indicator 0 (physician service; the professional/technical split does not apply).

PFS relative values and national payment for G0421
ComponentNon-facilityFacility
Work RVU0.500.50
Practice expense RVU0.29NA
Malpractice RVU0.030.03
Total RVUs0.82NA
National payment (CF $33.4009)$27.39n/a
Qualifying APM participant (CF $33.5675)$27.53n/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 A (Services not paid under OPPS; paid under fee schedule or other payment system), with no separate OPPS payment rate.

Medically Unlikely Edits for G0421

CMS caps G0421 at practitioner 2 (MAI 3, Clinical: Data); hospital outpatient 2 (MAI 3, Clinical: Data) units per day in the 2026 Q4 MUE tables. The practitioner MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for G0421 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services23 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital23 Date of Service Edit: ClinicalClinical: Data

The MUE lookup for G0421 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, G0421 is the column-2 (bundled) code in 1 active pair, 100% of which allow a modifier and the column-1 code in 4 (0% modifier-allowed); 4 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 codes most often paired with G0421 (practitioner)
Column-1 codePairs
G0420 Ed svc ckd ind per session1
Column-2 codes bundled into G0421 (practitioner)
Column-2 codePairs
36591 (CPT; descriptor licensed by AMA)1
36592 (CPT; descriptor licensed by AMA)1
96523 (CPT; descriptor licensed by AMA)1
99452 (CPT; descriptor licensed by AMA)1

In the hospital outpatient PTP file v323r0, G0421 is the column-2 (bundled) code in 1 active pair, 100% of which allow a modifier and the column-1 code in 1 (0% modifier-allowed); 1 earlier pair has been deleted. CMS's most frequent rationale for the bundled pairs: Misuse of Column Two code with Column One code.

Column-1 codes most often paired with G0421 (hospital outpatient)
Column-1 codePairs
G0420 Ed svc ckd ind per session1
Column-2 codes bundled into G0421 (hospital outpatient)
Column-2 codePairs
99452 (CPT; descriptor licensed by AMA)1

G0421 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 G0421 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0421

No current LCD or billing and coding article lists G0421. The HCPCS coverage code C means carrier judgment, so the Medicare contractor decides coverage, and any National Coverage Determination for the service still applies.

Telehealth status

G0421 is on the CY2026 Medicare telehealth services list (CMS action: Maintain). Bill it with the place-of-service code and modifiers that match where the patient and the practitioner are on the date of service.

Denials to expect on G0421

CARC 50 · N115

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

CARC 151 · N362

units of G0421 exceed the practitioner 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 G0421 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0421 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 G0421

What does HCPCS code G0421 describe?

"Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour" (short descriptor "Ed svc ckd grp per session"), in the G section (procedures and professional services, temporary). Added 2010-01-01.

Is G0421 a CPT code?

It is not. G0421 belongs to the G section (procedures and professional services, temporary) of HCPCS Level II, the CMS code set, not to AMA CPT.

What does Medicare pay for G0421?

National PFS payment for G0421 is $27.39 in an office and no facility amount in a facility (October 2026), built from 0.50 work, 0.29 practice-expense and 0.03 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $27.53 at $33.5675.

How many units of G0421 can be billed per day?

CMS caps G0421 at practitioner 2 (MAI 3, Clinical: Data); hospital outpatient 2 (MAI 3, Clinical: Data) units per day in the 2026 Q4 MUE tables. For the practitioner 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 G0421?

No current LCD or billing article lists G0421; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage).

Can G0421 be billed as telehealth?

Yes. G0421 is on the CY2026 Medicare telehealth list (Maintain); the place-of-service and modifier rules on the date of service still 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.

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.