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HCPCS G0426 · Level II · G code

G0426: Telehealth consultation, emergency department or initial inpatient, 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 G0426

Medicare payment
$117.24
PFS facility, national
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
1
MAI 3
OPPS status
SI B
Non-allowed item or service for OPPS
NCCI PTP pairs
513
3 hospital outpatient
LCDs and articles
0 / 0
on the Medicare telehealth list

TL;DR

HCPCS Level II G0426 reads "Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth" in the October 2026 file; it dates from 2010. Medicare's October 2026 physician fee schedule pays G0426 no non-facility amount non-facility and $117.24 facility nationally, from 2.61 work, 0.67 practice-expense and 0.23 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $117.82 at $33.5675. MUE limits for G0426: practitioner 1 (MAI 3, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 3, Code Descriptor / CPT Instruction). In the NCCI PTP files v323r0 G0426 appears in 421 practitioner pairs as column 2 and 92 as column 1 (most often with 00100, 00102, 00103), and in 3 hospital outpatient pairs as column 2 and 0 as column 1. G0426 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. It is on the CY2026 Medicare telehealth list (CMS action: Maintain). OPPS status indicator B: Non-allowed item or service for OPPS. HCPCS record: BETOS M6 (consultations); pricing indicator 13; type of service 3 (consultation). 4 other active codes open with "Telehealth consultation"; related codes: G0425, G0427, G0508, G0509.

G0426 descriptor and code status

The October 2026 HCPCS Level II file describes G0426 as “Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0426 CPT code", G0426 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 G0426
FieldValue
Short descriptorInpt/ed teleconsult50
Added to HCPCS2010-01-01
Last actionN (no maintenance), effective 2012-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator13: physician fee schedule, priced by the contractor
BETOS categoryM6: consultations
Type of service3: consultation

Medicare payment for G0426

Medicare's October 2026 physician fee schedule pays G0426 no non-facility amount non-facility and $117.24 facility nationally, from 2.61 work, 0.67 practice-expense and 0.23 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $117.82 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 G0426
ComponentNon-facilityFacility
Work RVU2.612.61
Practice expense RVUNA0.67
Malpractice RVU0.230.23
Total RVUsNA3.51
National payment (CF $33.4009)n/a$117.24
Qualifying APM participant (CF $33.5675)n/a$117.82
  • 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 B (Non-allowed item or service for OPPS), with no separate OPPS payment rate.

Medically Unlikely Edits for G0426

MUE limits for G0426: practitioner 1 (MAI 3, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 3, Code Descriptor / CPT Instruction). 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 G0426 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services13 Date of Service Edit: ClinicalCode Descriptor / CPT Instruction
Facility outpatient hospital13 Date of Service Edit: ClinicalCode Descriptor / CPT Instruction

The MUE lookup for G0426 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, G0426 is the column-2 (bundled) code in 421 active pairs, 17% of which allow a modifier and the column-1 code in 92 (29% modifier-allowed); 584 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 G0426 (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 G0426 (practitioner)
Column-2 codePairs
36591 (CPT; descriptor licensed by AMA)1
36592 (CPT; descriptor licensed by AMA)1
43752 (CPT; descriptor licensed by AMA)1
80503 (CPT; descriptor licensed by AMA)1
80504 (CPT; descriptor licensed by AMA)1
80505 (CPT; descriptor licensed by AMA)1
80506 (CPT; descriptor licensed by AMA)1
90832 (CPT; descriptor licensed by AMA)1

In the hospital outpatient PTP file v323r0, G0426 is the column-2 (bundled) code in 3 active pairs, 100% of which allow a modifier and the column-1 code in 0; 0 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: CPT Manual or CMS manual coding instruction.

Column-1 codes most often paired with G0426 (hospital outpatient)
Column-1 codePairs
0884T (CPT; descriptor licensed by AMA)1
0886T (CPT; descriptor licensed by AMA)1
0889T (CPT; descriptor licensed by AMA)1

G0426 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 G0426 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0426

No current LCD or billing and coding article lists G0426. 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

G0426 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 G0426

CARC 50 · N115

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

CARC 151 · N362

units of G0426 exceed the practitioner MUE of 1 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks the description, invoice or pricing detail a contractor-priced code needs

Where QuickIntell fits for G0426 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0426 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 G0426

What does HCPCS code G0426 describe?

"Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth" (short descriptor "Inpt/ed teleconsult50"), in the G section (procedures and professional services, temporary). Added 2010-01-01; last action N (no maintenance) effective 2012-01-01.

Is G0426 a CPT code?

No: CMS maintains G0426 in HCPCS Level II, while the AMA maintains CPT. People do search "G0426 CPT code", and it goes in the same procedure-code field.

What does Medicare pay for G0426?

Medicare's October 2026 physician fee schedule pays G0426 no non-facility amount non-facility and $117.24 facility nationally, from 2.61 work, 0.67 practice-expense and 0.23 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $117.82 at $33.5675.

How many units of G0426 can be billed per day?

MUE limits for G0426: practitioner 1 (MAI 3, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 3, Code Descriptor / CPT Instruction). For the practitioner 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 G0426?

G0426 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.

Can G0426 be billed as telehealth?

Yes. G0426 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.