G0426 — Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth
G0426 is a HCPCS Level II code for telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth. It belongs to the Procedures and Professional Services (Temporary) section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusA
Active code. Paid separately under the physician fee schedule.
- Work RVU
- 2.61
- PE (non-facility)
- 0.67
- PE (facility)
- 0.67
- Malpractice RVU
- 0.23
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of G0426 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 1 unit MAI 3 — Date of Service Edit: Clinical · Code Descriptor / CPT Instruction
- outpatient
- 1 unit MAI 3 — Date of Service Edit: Clinical · Code Descriptor / CPT Instruction
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for G0426
- Long descriptor
- Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth
- Short descriptor
- Inpt/ed teleconsult50
- Added
- January 1, 2010
- BETOS
- M6
- Pricing indicator
- 13 — Physician fee schedule
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Price established by carriers — not otherwise classified, individual determination, or carrier discretion.
Codes adjacent to G0426
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G0426 is not quite right, the correct code is very often within a few positions of it.
- G0418Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 41-60 specimensterminated
- G0419Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, >60 specimensterminated
- G0420Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour
- G0421Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour
- G0422Intensive cardiac rehabilitation; with or without continuous ecg monitoring with exercise, per session
- G0423Intensive cardiac rehabilitation; with or without continuous ecg monitoring; without exercise, per session
- G0424Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per dayterminated
- G0425Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth
- G0427Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth
- G0428Collagen meniscus implant procedure for filling meniscal defects (e.g., cmi, collagen scaffold, menaflex)
- G0429Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (lds) (e.g., as a result of highly active antiretroviral therapy)
- G0431Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounterterminated
- G0432Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening
- G0433Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening
- G0434Drug screen, other than chromatographic; any number of drug classes, by clia waived test or moderate complexity test, per patient encounterterminated
- G0435Infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, screening
Questions about G0426
What is HCPCS code G0426?
G0426 is a HCPCS Level II code for telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth. It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G0426?
The CMS HCPCS file marks G0426 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is G0426 paid under the physician fee schedule?
G0426 carries PFS status code A. Active code. Paid separately under the physician fee schedule.