`G0426` Inpt/ed teleconsult50

What G0426 is

Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth

HCPCS Level II long description, CMS October 2026 file. See the G codes page for the full section.

Medicare payment for G0426 (CY2026)

	Work RVU	Practice expense RVU	Malpractice RVU	Total	Medicare rate
Non-facility (office)	2.61	0.67	0.23	3.51	$117.24
Facility (hospital, ASC)	2.61	0.67	0.23	3.51	$117.24

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.

Adjust for a Medicare locality:

Status: Active - payable under the Physician Fee Schedule. Global period: Global concept does not apply.

Medically Unlikely Edit (MUE)

Medicare caps G0426 at 1 unit 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: Code Descriptor / CPT Instruction. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.

Billed with G0426? These codes are bundled into it

G0426 is a Column 1 code in 92 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
`43752`	Nasal/orogastric w/tube plmt	1 - modifier may bypass	Check pair
`80503`	Path clin consltj sf 5-20	0 - no modifier bypass	Check pair
`80504`	Path clin consltj mod 21-40	0 - no modifier bypass	Check pair
`80505`	Path clin consltj high 41-60	0 - no modifier bypass	Check pair
`80506`	Path clin consltj prolng svc	0 - no modifier bypass	Check pair
`90832`	Psytx w pt 30 minutes	0 - no modifier bypass	Check pair
`90833`	Psytx w pt w e/m 30 min	0 - no modifier bypass	Check pair
`90834`	Psytx w pt 45 minutes	0 - no modifier bypass	Check pair
`90836`	Psytx w pt w e/m 45 min	0 - no modifier bypass	Check pair
`90839`	Psytx crisis initial 60 min	0 - no modifier bypass	Check pair
`90840`	Psytx crisis ea addl 30 min	0 - no modifier bypass	Check pair
`90940`	Hemodialysis access study	0 - no modifier bypass	Check pair
`92002`	Intrm oph exam new patient	0 - no modifier bypass	Check pair
`92004`	Compre oph exam new pt 1/>	0 - no modifier bypass	Check pair
`92012`	Intrm oph exam est patient	0 - no modifier bypass	Check pair
`92014`	Compre oph exam est pt 1/>	0 - no modifier bypass	Check pair
`92531`	Spontaneous nystagmus study	0 - no modifier bypass	Check pair
`92532`	Positional nystagmus test	0 - no modifier bypass	Check pair
`93793`	Anticoag mgmt pt warfarin	1 - modifier may bypass	Check pair
`94002`	Vent mgmt inpat init day	0 - no modifier bypass	Check pair
`94003`	Vent mgmt inpat subq day	0 - no modifier bypass	Check pair
`94004`	Vent mgmt nf per day	0 - no modifier bypass	Check pair
`94644`	Cont inhlj tx 1st hour	1 - modifier may bypass	Check pair
`94660`	Cpap initiation&mgmt	0 - no modifier bypass	Check pair
`95851`	Range of motion measurements	0 - no modifier bypass	Check pair
`95852`	Range of motion measurements	0 - no modifier bypass	Check pair
`96020`	Functional brain mapping	1 - modifier may bypass	Check pair
`96116`	Nubhvl xm phys/qhp 1st hr	1 - modifier may bypass	Check pair

Showing 30 of 92 column 2 codes. Use the pair checker for any specific combination.

G0426 is bundled into these codes

G0426 appears as a Column 2 code in 421 active edits. Reported with one of these Column 1 codes on the same date of service, G0426 is the code that denies.

Column 1 code	Short description
`00100`	Anes px salivary gland w/bx	Check pair
`00102`	Anes px plstc rpr cleft lip	Check pair
`00103`	Anes rcnstv px eyelid	Check pair
`00104`	Anes electroconvulsive ther	Check pair
`00120`	Anes px ear w/bx nos	Check pair
`00124`	Anes px ear otoscopy	Check pair
`00126`	Anes px ear tympanotomy	Check pair
`00140`	Anes procedures on eye nos	Check pair
`00142`	Anes px on eye lens surgery	Check pair
`00144`	Anes px eye corneal trnspl	Check pair
`00145`	Anes px eye vitreortnl surg	Check pair
`00147`	Anes px on eye iridectomy	Check pair
`00148`	Anes px eye ophthalmoscopy	Check pair
`00160`	Anes px nose&sinus nos	Check pair
`00162`	Anes px nose&sinus rad surg	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.