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HCPCS G0545 · Level II · G code

G0545: Inherent visit to inpt, 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 G0545

Medicare payment
$48.43
PFS non-facility, national; facility $40.42
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
1
MAI 2
OPPS status
SI B
Non-allowed item or service for OPPS
NCCI PTP pairs
0
practitioner file
LCDs and articles
0 / 0
on the Medicare telehealth list

TL;DR

CMS describes HCPCS G0545, added in 2025, as "Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease by an infectious diseases specialist, including disease transmission risk assessment and mitigation, public health investigation, analysis, and testing, and complex antimicrobial therapy counseling and treatment (add-on code, list separately in addition to hospital inpatient or observation evaluation and management visit, initial, same day discharge, subsequent or discharge)". Under the 2026 physician fee schedule (October release) G0545 carries 0.89 work, 0.49 practice-expense and 0.07 malpractice RVUs, which at $33.4009 per RVU pays $48.43 non-facility and $40.42 facility before the locality adjustment. Qualifying APM participants get $48.67 at $33.5675. Global period ZZZ (add-on service inside the primary service's global period). Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). G0545 is an add-on code (NCCI edit type 1): Medicare pays it only on a claim that also carries one of 15 primary codes such as 99221, 99222, 99223, 99231. G0545 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: Addition). OPPS status indicator B: Non-allowed item or service for OPPS. HCPCS record: BETOS M5D (specialist - other); pricing indicator 13; type of service 1 (medical care). Nearby codes: G0544, G0542, G0541, G0539.

G0545 descriptor and code status

The October 2026 HCPCS Level II file describes G0545 as “Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease by an infectious diseases specialist, including disease transmission risk assessment and mitigation, public health investigation, analysis, and testing, and complex antimicrobial therapy counseling and treatment (add-on code, list separately in addition to hospital inpatient or observation evaluation and management visit, initial, same day discharge, subsequent or discharge)”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0545 CPT code", G0545 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 G0545
FieldValue
Short descriptorInherent visit to inpt
Added to HCPCS2025-01-01
Last actionN (no maintenance), effective 2025-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator13: physician fee schedule, priced by the contractor
BETOS categoryM5D: specialist - other
Type of service1: medical care

Medicare payment for G0545

Under the 2026 physician fee schedule (October release) G0545 carries 0.89 work, 0.49 practice-expense and 0.07 malpractice RVUs, which at $33.4009 per RVU pays $48.43 non-facility and $40.42 facility before the locality adjustment. Qualifying APM participants get $48.67 at $33.5675. Global period ZZZ (add-on service inside the primary service's global period). 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 ZZZ (add-on service inside the primary service's global period); PC/TC indicator 0 (physician service; the professional/technical split does not apply).

PFS relative values and national payment for G0545
ComponentNon-facilityFacility
Work RVU0.890.89
Practice expense RVU0.490.25
Malpractice RVU0.070.07
Total RVUs1.451.21
National payment (CF $33.4009)$48.43$40.42
Qualifying APM participant (CF $33.5675)$48.67$40.62
  • 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 G0545

Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). 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 G0545 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction
Facility outpatient hospital12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction

The MUE lookup for G0545 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists G0545 in v323r0.

G0545 is an add-on code: it is payable only with a primary service on the same claim (99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99252, and others). CPT primary codes are shown as numbers only.

Pair counts show exposure, not the answer for one claim. Check G0545 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0545

No current LCD or billing and coding article lists G0545. 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

G0545 is on the CY2026 Medicare telehealth services list (CMS action: Addition). 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 G0545

CARC 50 · N115

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

CARC 151 · N362

units of G0545 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 G0545 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0545 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 G0545

What does HCPCS code G0545 describe?

"Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease by an infectious diseases specialist, including disease transmission risk assessment and mitigation, public health investigation, analysis, and testing, and complex antimicrobial therapy counseling and treatment (add-on code, list separately in addition to hospital inpatient or observation evaluation and management visit, initial, same day discharge, subsequent or discharge)" (short descriptor "Inherent visit to inpt"), in the G section (procedures and professional services, temporary). Added 2025-01-01.

Is G0545 a CPT code?

No. G0545 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set. Searches for "G0545 CPT code" mean this Level II code.

What does Medicare pay for G0545?

Under the 2026 physician fee schedule (October release) G0545 carries 0.89 work, 0.49 practice-expense and 0.07 malpractice RVUs, which at $33.4009 per RVU pays $48.43 non-facility and $40.42 facility before the locality adjustment. Qualifying APM participants get $48.67 at $33.5675. Global period ZZZ (add-on service inside the primary service's global period).

Is G0545 an add-on code?

G0545 is an add-on code (NCCI edit type 1): Medicare pays it only on a claim that also carries one of 15 primary codes such as 99221, 99222, 99223, 99231.

How many units of G0545 can be billed per day?

Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). For the practitioner MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover G0545?

G0545 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 G0545 be billed as telehealth?

Yes. G0545 is on the CY2026 Medicare telehealth list (Addition); the place-of-service and modifier rules on the date of service still apply.

CMS guidance

The Medicare Learning Network publication that CMS issues on this topic, cited by ICN and publication date:

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.