Key facts for G0451
- Medicare payment
- $12.36
- PFS non-facility, national
- Coverage code
- C
- carrier judgment, so the Medicare contractor decides coverage
- Practitioner MUE
- 1
- MAI 3
- NCCI PTP pairs
- 24
- 21 hospital outpatient
- LCDs and articles
- 6 / 4
TL;DR
CMS describes HCPCS G0451, added in 2012, as "Development testing, with interpretation and report, per standardized instrument form". National PFS payment for G0451 is $12.36 in an office and no facility amount in a facility (October 2026), built from 0.00 work, 0.36 practice-expense and 0.01 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $12.42 at $33.5675. CMS caps G0451 at practitioner 1 (MAI 3, Clinical: Data); hospital outpatient 1 (MAI 3, Clinical: Data) units per day in the 2026 Q4 MUE tables. In the NCCI PTP files v323r0 G0451 appears in 16 practitioner pairs as column 2 and 8 as column 1 (most often with 96105, 96112, 96113), and in 10 hospital outpatient pairs as column 2 and 11 as column 1. 6 active LCDs and 4 billing and coding articles list G0451 across 10 states plus DC and 2 territories: L33632 (Psychiatry and Psychology Services), L34520 (Psychological and Neuropsychological Tests), A52866, A56937. HCPCS record: BETOS M5D (specialist - other); pricing indicator 13; type of service 1 (medical care). Nearby codes: G0452, G0453, G0448, G0454.
G0451 descriptor and code status
The October 2026 HCPCS Level II file describes G0451 as “Development testing, with interpretation and report, per standardized instrument form”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes.
| Field | Value |
|---|---|
| Short descriptor | Devlopment test interpt&rep |
| Added to HCPCS | 2012-01-01 |
| Last action | N (no maintenance), effective 2012-01-01 |
| Coverage code | C: carrier judgment, so the Medicare contractor decides coverage |
| Pricing indicator | 13: physician fee schedule, priced by the contractor |
| BETOS category | M5D: specialist - other |
| Type of service | 1: medical care |
Medicare payment for G0451
National PFS payment for G0451 is $12.36 in an office and no facility amount in a facility (October 2026), built from 0.00 work, 0.36 practice-expense and 0.01 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $12.42 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 5 (incident-to service).
| Component | Non-facility | Facility |
|---|---|---|
| Work RVU | 0.00 | 0.00 |
| Practice expense RVU | 0.36 | NA |
| Malpractice RVU | 0.01 | 0.01 |
| Total RVUs | 0.37 | NA |
| National payment (CF $33.4009) | $12.36 | n/a |
| Qualifying APM participant (CF $33.5675) | $12.42 | n/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: general supervision unless furnished by a qualified psychologist
Hospital outpatient (OPPS Addendum B)
Status indicator Q3 (Codes that may be paid through a composite APC), APC 5822 (Level 2 Health and Behavior Services), national unadjusted payment $103.79 with a minimum unadjusted copayment of $20.76.
Medically Unlikely Edits for G0451
CMS caps G0451 at practitioner 1 (MAI 3, Clinical: Data); hospital outpatient 1 (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.
| Setting | MUE (units/DOS) | MAI | CMS rationale |
|---|---|---|---|
| Practitioner services | 1 | 3 Date of Service Edit: Clinical | Clinical: Data |
| Facility outpatient hospital | 1 | 3 Date of Service Edit: Clinical | Clinical: Data |
The MUE lookup for G0451 shows every setting next to any other code on the same claim.
NCCI edits and add-on rules
In the practitioner PTP file v323r0, G0451 is the column-2 (bundled) code in 16 active pairs, 88% of which allow a modifier and the column-1 code in 8 (50% modifier-allowed); 24 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Mutually exclusive procedures.
| Column-1 code | Pairs |
|---|---|
| 96105 (CPT; descriptor licensed by AMA) | 1 |
| 96112 (CPT; descriptor licensed by AMA) | 1 |
| 96113 (CPT; descriptor licensed by AMA) | 1 |
| 96116 (CPT; descriptor licensed by AMA) | 1 |
| 96121 (CPT; descriptor licensed by AMA) | 1 |
| 96130 (CPT; descriptor licensed by AMA) | 1 |
| 96131 (CPT; descriptor licensed by AMA) | 1 |
| 96132 (CPT; descriptor licensed by AMA) | 1 |
| Column-2 code | Pairs |
|---|---|
| 36591 (CPT; descriptor licensed by AMA) | 1 |
| 36592 (CPT; descriptor licensed by AMA) | 1 |
| 96125 (CPT; descriptor licensed by AMA) | 1 |
| 96127 (CPT; descriptor licensed by AMA) | 1 |
| 96146 (CPT; descriptor licensed by AMA) | 1 |
| 96160 (CPT; descriptor licensed by AMA) | 1 |
| 96161 (CPT; descriptor licensed by AMA) | 1 |
| 96523 (CPT; descriptor licensed by AMA) | 1 |
In the hospital outpatient PTP file v323r0, G0451 is the column-2 (bundled) code in 10 active pairs, 80% of which allow a modifier and the column-1 code in 11 (100% modifier-allowed); 24 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: More extensive procedure.
| Column-1 code | Pairs |
|---|---|
| 96105 (CPT; descriptor licensed by AMA) | 1 |
| 96112 (CPT; descriptor licensed by AMA) | 1 |
| 96113 (CPT; descriptor licensed by AMA) | 1 |
| 96116 (CPT; descriptor licensed by AMA) | 1 |
| 96121 (CPT; descriptor licensed by AMA) | 1 |
| 96130 (CPT; descriptor licensed by AMA) | 1 |
| 96132 (CPT; descriptor licensed by AMA) | 1 |
| 96156 (CPT; descriptor licensed by AMA) | 1 |
| Column-2 code | Pairs |
|---|---|
| 96125 (CPT; descriptor licensed by AMA) | 1 |
| 96127 (CPT; descriptor licensed by AMA) | 1 |
| 96131 (CPT; descriptor licensed by AMA) | 1 |
| 96133 (CPT; descriptor licensed by AMA) | 1 |
| 96136 (CPT; descriptor licensed by AMA) | 1 |
| 96137 (CPT; descriptor licensed by AMA) | 1 |
| 96138 (CPT; descriptor licensed by AMA) | 1 |
| 96139 (CPT; descriptor licensed by AMA) | 1 |
G0451 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 G0451 against a second code to see whether the pair bundles and whether a modifier can separate the services.
Medicare coverage policies for G0451
6 active Local Coverage Determinations and 4 billing and coding articles list G0451. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.
- Psychiatry and Psychology Services (L33632) · Wellpoint Federal
- LCD L34520: Psychological and Neuropsychological Tests · First Coast Service Options, Inc.
- Bariatric Surgical Management of Morbid Obesity, LCD L35022 · Novitas Solutions, Inc.
- Speech - Language Pathology (SLP) Services: Communication Disorders (L35070) · Novitas Solutions, Inc.
- LCD L35101: Psychiatric Codes · Novitas Solutions, Inc.
- L33580 Speech-Language Pathology · Wellpoint Federal
| Article | Title | Contractor(s) | Related LCD |
|---|---|---|---|
| A52866 | Billing and Coding: Speech-Language Pathology | Wellpoint Federal | L33580 |
| A56937 | Billing and Coding: Psychiatry and Psychology Services | Wellpoint Federal | L33632 |
| A57130 | Billing and Coding: Psychiatric Codes | Novitas Solutions, Inc. | L35022, L35070, L35101 |
| A57780 | Billing and Coding: Psychological and Neuropsychological Tests | First Coast Service Options, Inc. | L34520 |
Denials to expect on G0451
the diagnosis or documentation does not meet the LCD or billing article that lists G0451
the modifier reported is inconsistent with the code
the claim lacks the description, invoice or pricing detail a contractor-priced code needs
Where QuickIntell fits for G0451 claims
QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0451 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.
Frequently asked questions: HCPCS G0451
What does HCPCS code G0451 describe?
"Development testing, with interpretation and report, per standardized instrument form" (short descriptor "Devlopment test interpt&rep"), in the G section (procedures and professional services, temporary). Added 2012-01-01.
Is G0451 a CPT code?
It is not. G0451 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 G0451?
National PFS payment for G0451 is $12.36 in an office and no facility amount in a facility (October 2026), built from 0.00 work, 0.36 practice-expense and 0.01 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $12.42 at $33.5675.
How many units of G0451 can be billed per day?
CMS caps G0451 at practitioner 1 (MAI 3, Clinical: Data); hospital outpatient 1 (MAI 3, Clinical: Data) units per day in the 2026 Q4 MUE tables. 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 G0451?
Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 6 active LCDs and 4 billing and coding articles list G0451 across 10 states plus DC and 2 territories: L33632 (Psychiatry and Psychology Services), L34520 (Psychological and Neuropsychological Tests), A52866, A56937.
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.
- HCPCS Level II alpha-numeric file, October 2026Version October 2026 · effective 2026-10-01 · file HCPC2026_OCT_ANWEB_09232026.txtSHA-256 c25240c63108756d…
- Medicare PFS national relative value file RVU26D (non-QPP), October 2026Version RVU26D, released 2026-08-26 · effective 2026-10-01 · file PPRRVU2026_Oct_nonQPP.csvSHA-256 4d0d3f19bd954ffc…
- Medicare PFS national relative value file RVU26D (qualifying APM participants), October 2026Version RVU26D, released 2026-08-26 · effective 2026-10-01 · file PPRRVU2026_Oct_QPP.csvSHA-256 59d3734704853936…
- OPPS Addendum B, October 2026Version October 2026 · effective 2026-10-01 · file 508-compliant-version-2026_October_Web_Addendum_B.09.28.26.csvSHA-256 6ad7393a318bf1b9…
- Integrated Outpatient Code Editor v27.3 data tables: status and payment indicatorsVersion I/OCE v27.3 (October 2026) · effective 2026-10-01 · file Data_Status_Indicator.txtSHA-256 78f119ef0a435351…
- NCCI MUE table, practitioner services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_PractitionerServices_Eff_10-01-2026.csvSHA-256 ef038efaf902b7bd…
- NCCI MUE table, facility services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_OutpatientHospitalServices_Eff_10-01-2026.csvSHA-256 3af9f4e99cc587e2…
- NCCI MUE table, dme services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_DMESupplierServices_Eff_10-01-2026.csvSHA-256 6fa4fbba852f7b74…
- NCCI PTP edits, practitioner, v323r0 (four files)Version v323r0 (2026 Q4) · effective 2026-10-01 · file ccipra-v323r0-f1.TXTSHA-256 7793c0b6686c1e22…
- NCCI PTP edits, hospital outpatient, v323r0 (four files)Version v323r0 (2026 Q4) · effective 2026-10-01 · file ccioph-v323r0-f1.txtSHA-256 063f41b91ef9faa2…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-10-08 · effective 2026-10-04 · file article.csvSHA-256 5e95c4a8ac3664be…
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-10-08 · effective 2026-10-04 · file lcd.csvSHA-256 9aee1bd7f14056b0…
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.