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HCPCS G0423 · Level II · G code

G0423: Intensive cardiac rehabilitation; with or without continuous ECG monitoring, 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); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 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; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for G0423

Medicare payment
$131.60
PFS non-facility, national; facility $131.60
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
6
MAI 2
OPPS status
SI S
Procedure or service, not discounted when multiple
NCCI PTP pairs
55
52 hospital outpatient
LCDs and articles
0 / 1
on the Medicare telehealth list

TL;DR

HCPCS Level II G0423 reads "Intensive cardiac rehabilitation; with or without continuous ecg monitoring; without exercise, per session" in the October 2026 file; it dates from 2010. Medicare's October 2026 physician fee schedule pays G0423 $131.60 non-facility and $131.60 facility nationally, from 2.05 work, 1.77 practice-expense and 0.12 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $132.26 at $33.5675. MUE limits for G0423: practitioner 6 (MAI 2, CMS Policy); hospital outpatient 6 (MAI 2, CMS Policy). In the NCCI PTP files v323r0 G0423 appears in 2 practitioner pairs as column 2 and 53 as column 1 (most often with 93351, G0422), and in 2 hospital outpatient pairs as column 2 and 50 as column 1. 1 billing and coding article lists G0423 across 4 states: A53775. It is on the CY2026 Medicare telehealth list (CMS action: Maintain). HCPCS record: BETOS M5D (specialist - other); pricing indicator 11; type of service 1 (medical care). 1 other active code opens with "Intensive cardiac rehabilitation"; related codes: G0422, G0425, G0420, G0426.

G0423 descriptor and code status

The October 2026 HCPCS Level II file describes G0423 as “Intensive cardiac rehabilitation; with or without continuous ecg monitoring; without exercise, per session”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0423 CPT code", G0423 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 G0423
FieldValue
Short descriptorIntens cardiac rehab no exer
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 categoryM5D: specialist - other
Type of service1: medical care

Medicare payment for G0423

Medicare's October 2026 physician fee schedule pays G0423 $131.60 non-facility and $131.60 facility nationally, from 2.05 work, 1.77 practice-expense and 0.12 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $132.26 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 G0423
ComponentNon-facilityFacility
Work RVU2.052.05
Practice expense RVU1.771.77
Malpractice RVU0.120.12
Total RVUs3.943.94
National payment (CF $33.4009)$131.60$131.60
Qualifying APM participant (CF $33.5675)$132.26$132.26
  • 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 S (Procedure or service, not discounted when multiple), APC 5771 (Cardiac Rehabilitation), national unadjusted payment $131.70 with a minimum unadjusted copayment of $26.34.

Medically Unlikely Edits for G0423

MUE limits for G0423: practitioner 6 (MAI 2, CMS Policy); hospital outpatient 6 (MAI 2, CMS Policy). The practitioner MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.

MUE values for G0423 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services62 Date of Service Edit: PolicyCMS Policy
Facility outpatient hospital62 Date of Service Edit: PolicyCMS Policy

The MUE lookup for G0423 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, G0423 is the column-2 (bundled) code in 2 active pairs, 100% of which allow a modifier and the column-1 code in 53 (79% modifier-allowed); 26 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Mutually exclusive procedures.

Column-1 codes most often paired with G0423 (practitioner)
Column-1 codePairs
93351 (CPT; descriptor licensed by AMA)1
G0422 Intens cardiac rehab w/exerc1
Column-2 codes bundled into G0423 (practitioner)
Column-2 codePairs
0596T (CPT; descriptor licensed by AMA)1
0597T (CPT; descriptor licensed by AMA)1
0903T (CPT; descriptor licensed by AMA)1
0904T (CPT; descriptor licensed by AMA)1
0905T (CPT; descriptor licensed by AMA)1
36000 (CPT; descriptor licensed by AMA)1
36410 (CPT; descriptor licensed by AMA)1
36591 (CPT; descriptor licensed by AMA)1

In the hospital outpatient PTP file v323r0, G0423 is the column-2 (bundled) code in 2 active pairs, 100% of which allow a modifier and the column-1 code in 50 (90% modifier-allowed); 26 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Mutually exclusive procedures.

Column-1 codes most often paired with G0423 (hospital outpatient)
Column-1 codePairs
93351 (CPT; descriptor licensed by AMA)1
G0422 Intens cardiac rehab w/exerc1
Column-2 codes bundled into G0423 (hospital outpatient)
Column-2 codePairs
0596T (CPT; descriptor licensed by AMA)1
0597T (CPT; descriptor licensed by AMA)1
0903T (CPT; descriptor licensed by AMA)1
0904T (CPT; descriptor licensed by AMA)1
0905T (CPT; descriptor licensed by AMA)1
36000 (CPT; descriptor licensed by AMA)1
36410 (CPT; descriptor licensed by AMA)1
51701 (CPT; descriptor licensed by AMA)1

G0423 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 G0423 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0423

0 active Local Coverage Determinations and 1 billing and coding article list G0423. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Billing and Coding Articles listing G0423
ArticleTitleContractor(s)Related LCD
A53775Billing and Coding: Frequency and Duration for Cardiac Rehabilitation and Intensive Cardiac RehabilitationPalmetto GBA—

Telehealth status

G0423 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 G0423

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists G0423

CARC 151 · N362

units of G0423 exceed the practitioner MUE of 6 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 G0423 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0423 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 G0423

What does HCPCS code G0423 describe?

"Intensive cardiac rehabilitation; with or without continuous ecg monitoring; without exercise, per session" (short descriptor "Intens cardiac rehab no exer"), in the G section (procedures and professional services, temporary). Added 2010-01-01.

Is G0423 a CPT code?

No: CMS maintains G0423 in HCPCS Level II, while the AMA maintains CPT. People do search "G0423 CPT code", and it goes in the same procedure-code field.

What does Medicare pay for G0423?

Medicare's October 2026 physician fee schedule pays G0423 $131.60 non-facility and $131.60 facility nationally, from 2.05 work, 1.77 practice-expense and 0.12 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $132.26 at $33.5675.

How many units of G0423 can be billed per day?

MUE limits for G0423: practitioner 6 (MAI 2, CMS Policy); hospital outpatient 6 (MAI 2, CMS Policy). For the practitioner MUE (MAI 2), units above 6 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover G0423?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 1 billing and coding article lists G0423 across 4 states: A53775.

Can G0423 be billed as telehealth?

Yes. G0423 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.