Summary & Overview
HCPCS G0406: Follow-up Inpatient Telehealth Consultation, Limited
HCPCS Level II code G0406 denotes a limited follow-up inpatient consultation delivered via telehealth, typically requiring about 15 minutes of physician-patient communication. Nationally, this code matters as inpatient telehealth follow-up visits have grown in use, affecting documentation workflows, telehealth platform requirements, and payer coverage policies. The code helps distinguish brief, focused inpatient telehealth follow-up services from longer or more comprehensive inpatient consultations and other evaluation-and-management services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, common billing and documentation considerations, payer coverage patterns, and relevant benchmarks where available. The publication outlines how G0406 is positioned relative to other inpatient and telehealth consultation codes and summarizes common modifiers and operational notes for billing teams.
This material is intended to provide a national perspective on code use, payer interactions, and the clinical setting for limited inpatient telehealth follow-up consultations. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code G0406 represents a follow-up inpatient consultation, limited, provided via telehealth. The service description indicates physicians typically spend 15 minutes communicating with the patient.
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Service type: Limited follow-up inpatient consultation via telehealth
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Typical site of service: Inpatient setting (telehealth communication with an admitted patient)
Clinical & Coding Specifications
Clinical Context
A hospitalized patient with an acute medical condition (for example, acute decompensated heart failure or community-acquired pneumonia) requires a specialty follow-up assessment after an initial inpatient consult. The patient is in a hospital room and the consultant physician connects by telehealth to the patient and the primary inpatient team. The physician spends approximately 15 minutes performing a focused history review, reviewing recent labs and imaging, confirming response to initial treatment, and communicating recommendations to the patient and inpatient team. Documentation includes reason for consult, focused exam findings or virtual inspection, assessment, and specific plan or changes in management. The encounter is billed as a limited follow-up inpatient consultation under G0406 with applicable place-of-service and telehealth modifiers when required. Typical workflow: the inpatient team places the consult request, the consultant reviews chart and relevant data, schedules a brief telehealth session, completes documentation in the medical record, and communicates recommendations to the primary team and the patient or their surrogate.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
95 | Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system | When the follow-up inpatient consultation is delivered live via telehealth video |