G0421 Ed svc ckd grp per session
What G0421 is
Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour
HCPCS Level II long description, CMS October 2026 file. See the G codes page for the full section.
Medicare payment for G0421 (CY2026)
| Work RVU | Practice expense RVU | Malpractice RVU | Total | Medicare rate | |
|---|---|---|---|---|---|
| Non-facility (office) | 0.50 | 0.29 | 0.03 | 0.82 | $27.39 |
| Facility (hospital, ASC) | 0.50 | 0.29 | 0.03 | 0.82 | $27.39 |
National rates: total RVUs x the CY2026 conversion factor of 33.4009 (non-QP), before geographic adjustment. Actual Medicare payment is 80% of the rate shown after the deductible; the patient or secondary payer owes the 20% coinsurance.
Status: Active - payable under the Physician Fee Schedule. Global period: Global concept does not apply.
Medically Unlikely Edit (MUE)
Medicare caps G0421 at 2 units per date of service for practitioner claims (MAI 3 - date of service edit (clinical): units above the MUE may pay with documentation on appeal), rationale: Clinical: Data. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.
Billed with G0421? These codes are bundled into it
G0421 is a Column 1 code in 4 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.
| Column 2 code | Short description | Modifier indicator | |
|---|---|---|---|
36591 | Draw blood off venous device | 0 - no modifier bypass | Check pair |
36592 | Collect blood from picc | 0 - no modifier bypass | Check pair |
96523 | Irrig drug delivery device | 0 - no modifier bypass | Check pair |
99452 | Ntrprof ph1/ntrnet/ehr rfrl | 0 - no modifier bypass | Check pair |
G0421 is bundled into these codes
G0421 appears as a Column 2 code in 1 active edits. Reported with one of these Column 1 codes on the same date of service, G0421 is the code that denies.
| Column 1 code | Short description | Modifier indicator | |
|---|---|---|---|
G0420 | Ed svc ckd ind per session | 1 | Check pair |
Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.