G0458 Ldr prostate brachy comp rat
What G0458 is
Low dose rate (ldr) prostate brachytherapy services, composite rate
HCPCS Level II long description, CMS October 2026 file. See the G codes page for the full section.
Medicare payment for G0458 (CY2026)
This code has no Physician Fee Schedule rate: Excluded from the Physician Fee Schedule (paid under another system or not priced here). It may be paid under a different fee schedule (clinical laboratory, DMEPOS, anesthesia) or not paid at all - check the relevant CMS schedule.
Medically Unlikely Edit (MUE)
Medicare caps G0458 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: Nature of Service/Procedure. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.
Billed with G0458? These codes are bundled into it
G0458 is a Column 1 code in 228 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 | |
|---|---|---|---|
00860 | Anes xtrprtl px lwr abd nos | 0 - no modifier bypass | Check pair |
0213T | Njx paravert w/us cer/thor | 0 - no modifier bypass | Check pair |
0216T | Njx paravert w/us lumb/sac | 0 - no modifier bypass | Check pair |
0395T | Hdr elctr ntrst/ntrcv brchtx | 1 - modifier may bypass | Check pair |
0424U | 1 - modifier may bypass | Check pair | |
0433U | 0 - no modifier bypass | Check pair | |
0596T | Temp fml iu vlv-pmp 1st insj | 0 - no modifier bypass | Check pair |
0597T | Temp fml iu valve-pmp rplcmt | 0 - no modifier bypass | Check pair |
0903T | Ecg alg 12 lead reduced i&r | 1 - modifier may bypass | Check pair |
0904T | Ecg alg 12 ld rdcd trcg only | 1 - modifier may bypass | Check pair |
0905T | Ecg alg 12 ld rdcd i&r only | 1 - modifier may bypass | Check pair |
11920 | Correct skin color 6.0 cm/< | 0 - no modifier bypass | Check pair |
11921 | Correct skn color 6.1-20.0cm | 0 - no modifier bypass | Check pair |
12001 | Rpr s/n/ax/gen/trnk 2.5cm/< | 1 - modifier may bypass | Check pair |
12002 | Rpr s/n/ax/gen/trnk2.6-7.5cm | 1 - modifier may bypass | Check pair |
12004 | Rpr s/n/ax/gen/trk7.6-12.5cm | 1 - modifier may bypass | Check pair |
12005 | Rpr s/n/a/gen/trk12.6-20.0cm | 1 - modifier may bypass | Check pair |
12006 | Rpr s/n/a/gen/trk20.1-30.0cm | 1 - modifier may bypass | Check pair |
12007 | Rpr s/n/ax/gen/trnk >30.0 cm | 1 - modifier may bypass | Check pair |
12011 | Rpr f/e/e/n/l/m 2.5 cm/< | 1 - modifier may bypass | Check pair |
12013 | Rpr f/e/e/n/l/m 2.6-5.0 cm | 1 - modifier may bypass | Check pair |
12014 | Rpr f/e/e/n/l/m 5.1-7.5 cm | 1 - modifier may bypass | Check pair |
12015 | Rpr f/e/e/n/l/m 7.6-12.5 cm | 1 - modifier may bypass | Check pair |
12016 | Rpr fe/e/en/l/m 12.6-20.0 cm | 1 - modifier may bypass | Check pair |
12017 | Rpr fe/e/en/l/m 20.1-30.0 cm | 1 - modifier may bypass | Check pair |
12018 | Rpr f/e/e/n/l/m >30.0 cm | 1 - modifier may bypass | Check pair |
12020 | Tx supfc wnd dehsn smpl clsr | 1 - modifier may bypass | Check pair |
12021 | Tx supfc wnd dehsn w/packing | 1 - modifier may bypass | Check pair |
12031 | Intmd rpr s/a/t/ext 2.5 cm/< | 1 - modifier may bypass | Check pair |
12032 | Intmd rpr s/a/t/ext 2.6-7.5 | 1 - modifier may bypass | Check pair |
Showing 30 of 228 column 2 codes. Use the pair checker for any specific combination.
G0458 is bundled into these codes
G0458 appears as a Column 2 code in 6 active edits. Reported with one of these Column 1 codes on the same date of service, G0458 is the code that denies.
| Column 1 code | Short description | Modifier indicator | |
|---|---|---|---|
0403U | 1 | Check pair | |
77767 | Hdr rdncl skn surf brachytx | 0 | Check pair |
77768 | Hdr rdncl skn surf brachytx | 0 | Check pair |
77770 | Hdr rdncl ntrstl/icav brchtx | 0 | Check pair |
77771 | Hdr rdncl ntrstl/icav brchtx | 0 | Check pair |
77772 | Hdr rdncl ntrstl/icav brchtx | 0 | 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.