G0459 Telehealth inpt pharm mgmt

What G0459 is

Inpatient telehealth pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy

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

Medicare payment for G0459 (CY2026)

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 G0459 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 G0459? These codes are bundled into it

G0459 is a Column 1 code in 38 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.

Showing 30 of 38 column 2 codes. Use the pair checker for any specific combination.

G0459 is bundled into these codes

G0459 appears as a Column 2 code in 242 active edits. Reported with one of these Column 1 codes on the same date of service, G0459 is the code that denies.

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.