Key facts for G0491
- Medicare payment
- no PFS amount
- PFS status X
- Coverage code
- C
- carrier judgment, so the Medicare contractor decides coverage
- Practitioner MUE
- 1
- MAI 3
- NCCI PTP pairs
- 290
- 259 hospital outpatient
- LCDs and articles
- 0 / 0
TL;DR
CMS describes HCPCS G0491, added in 2017, as "Dialysis procedure at a medicare certified esrd facility for acute kidney injury without esrd". The physician fee schedule lists G0491 with status X (statutory exclusion: not a physician service under the fee schedule), so the PFS carries no national amount for it. Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 3, Nature of Service/Procedure); hospital outpatient 1 (MAI 3, Nature of Service/Procedure). In the NCCI PTP files v323r0 G0491 appears in 5 practitioner pairs as column 2 and 285 as column 1 (most often with 90935, 90937, 90945), and in 1 hospital outpatient pairs as column 2 and 258 as column 1. G0491 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. OPPS status indicator B: Non-allowed item or service for OPPS. HCPCS record: BETOS P9A (dialysis services (Medicare fee schedule)); pricing indicator 13; type of service 1 (medical care). Nearby codes: G0498, G0499, G0500, G0481.
G0491 descriptor and code status
The October 2026 HCPCS Level II file describes G0491 as “Dialysis procedure at a medicare certified esrd facility for acute kidney injury without esrd”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0491 CPT code", G0491 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.
| Field | Value |
|---|---|
| Short descriptor | Dialysis acu kidney no esrd |
| Added to HCPCS | 2017-01-01 |
| Last action | N (no maintenance), effective 2017-01-01 |
| Coverage code | C: carrier judgment, so the Medicare contractor decides coverage |
| Pricing indicator | 13: physician fee schedule, priced by the contractor |
| BETOS category | P9A: dialysis services (Medicare fee schedule) |
| Type of service | 1: medical care |
Medicare payment for G0491
The physician fee schedule lists G0491 with status X (statutory exclusion: not a physician service under the fee schedule), so the PFS carries no national amount for it. 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 B (Non-allowed item or service for OPPS), with no separate OPPS payment rate.
Medically Unlikely Edits for G0491
Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 3, Nature of Service/Procedure); hospital outpatient 1 (MAI 3, Nature of Service/Procedure). 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 | Nature of Service/Procedure |
| Facility outpatient hospital | 1 | 3 Date of Service Edit: Clinical | Nature of Service/Procedure |
The MUE lookup for G0491 shows every setting next to any other code on the same claim.
NCCI edits and add-on rules
In the practitioner PTP file v323r0, G0491 is the column-2 (bundled) code in 5 active pairs, 20% of which allow a modifier and the column-1 code in 285 (57% modifier-allowed); 121 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Mutually exclusive procedures.
| Column-1 code | Pairs |
|---|---|
| 90935 (CPT; descriptor licensed by AMA) | 1 |
| 90937 (CPT; descriptor licensed by AMA) | 1 |
| 90945 (CPT; descriptor licensed by AMA) | 1 |
| 90947 (CPT; descriptor licensed by AMA) | 1 |
| G0257 Unsched dialysis esrd pt hos | 1 |
| Column-2 code | Pairs |
|---|---|
| 0596T (CPT; descriptor licensed by AMA) | 1 |
| 0597T (CPT; descriptor licensed by AMA) | 1 |
| 0708T (CPT; descriptor licensed by AMA) | 1 |
| 0709T (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 |
| 12001 (CPT; descriptor licensed by AMA) | 1 |
In the hospital outpatient PTP file v323r0, G0491 is the column-2 (bundled) code in 1 active pair, 100% of which allow a modifier and the column-1 code in 258 (98% modifier-allowed); 111 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 code | Pairs |
|---|---|
| G0257 Unsched dialysis esrd pt hos | 1 |
| Column-2 code | Pairs |
|---|---|
| 0596T (CPT; descriptor licensed by AMA) | 1 |
| 0597T (CPT; descriptor licensed by AMA) | 1 |
| 0708T (CPT; descriptor licensed by AMA) | 1 |
| 0709T (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 |
| 12001 (CPT; descriptor licensed by AMA) | 1 |
G0491 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 G0491 against a second code to see whether the pair bundles and whether a modifier can separate the services.
Medicare coverage policies for G0491
No current LCD or billing and coding article lists G0491. 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 G0491
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 G0491 claims
QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0491 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 G0491
What does HCPCS code G0491 describe?
"Dialysis procedure at a medicare certified esrd facility for acute kidney injury without esrd" (short descriptor "Dialysis acu kidney no esrd"), in the G section (procedures and professional services, temporary). Added 2017-01-01.
Is G0491 a CPT code?
No. G0491 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set. Searches for "G0491 CPT code" mean this Level II code.
What does Medicare pay for G0491?
The physician fee schedule lists G0491 with status X (statutory exclusion: not a physician service under the fee schedule), so the PFS carries no national amount for it.
How many units of G0491 can be billed per day?
Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 3, Nature of Service/Procedure); hospital outpatient 1 (MAI 3, Nature of Service/Procedure). 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 G0491?
G0491 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.
- 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…
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.