HCPCS G0425: Telehealth Consultation, Emergency or Initial Inpatient

Medicare pays $86 on average nationally for this procedure.

HCPCS Level II code G0425 describes a telehealth consultation for an emergency department visit or an initial inpatient consultation, typically a 30-minute synchronous audiovisual encounter between a clinician and a patient; service type: telehealth consultation, typical site of service: emergency department or initial inpatient setting.

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HCPCS G0425: Telehealth Consultation, Emergency or Initial Inpatient

Medicare pays $86 on average nationally for this procedure.

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Sign up for hcpcs G0425 policy alerts

Get alerted when payer policies referencing G0425 are released or updated.

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Receive email alerts as soon as relevant payer policies are published or updated.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 58-year-old male presenting to an emergency department with acute shortness of breath and chest pain. The emergency physician requests a telehealth consultation with a remote hospitalist or cardiology consultant to assist with triage and initial inpatient management. The remote consultant conducts a synchronous audiovisual visit, reviews the ED clinician’s findings, bedside vitals, ECG, chest x-ray images via the health system’s secure image viewer, and discusses management recommendations with the ED team and the patient/family. The consultation lasts approximately 30 minutes and results in either admission to an inpatient service, transfer to a higher level of care, or discharge with follow-up. Clinical workflow: ED clinician initiates consult; telehealth appointment scheduled; consultant documents history, review of systems, assessment, and plan; consultant documents time spent, technology used, and consent when required; ED documents local care and implements consultant recommendations. This service aligns with billing code G0425 for a telehealth consultation in the emergency department or initial inpatient setting, typically 30 minutes of synchronous communication with the patient via telehealth.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99223`	Initial hospital care, typically 70 minutes or more on the first hospital inpatient encounter	Used when the patient is admitted and an extended initial inpatient face-to-face evaluation is performed after telehealth triage
`99285`	Emergency department visit for the evaluation and management of a patient with high severity, typically 40 minutes or longer	May be billed by the ED if the ED clinician provides the ED-level E/M service in conjunction with the telehealth consult
`99446`	Interprofessional telephone/Internet/electronic health record consult professional consult, 5-10 minutes of medical consultative discussion and review	Used for shorter interprofessional electronic consultations; relates when phone/e-consults supplement the telehealth consult
`99451`	Interprofessional e-consultation, physician time 5 minutes or more	Used when a consultant provides a written electronic consult without synchronous audiovisual patient interaction
`99091`	Collection and interpretation of physiologic data digitally stored and/or transmitted by the patient to the physician	May be used when remote monitoring data contribute to the telehealth consultation

Related Modifiers

5 rows

Modifier	Description	When to Use
95	Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…	- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
91	Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…	- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…
P6	Modifier P6 indicates a declared brain‑dead patient whose organs are being removed for donor purposes. It is part of the Anesthesia Physical Status Modifiers (P1–P6) and corresponds to ASA VI. The…	- When to use: Append CPT modifier P6 to anesthesia codes in the 00100–01999 range when the anesthesia provider documents a declared brain‑dead patient whose organs are being removed for donor…
[object Object]

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
2084P0800X	Psychiatry Physician	A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
207RH0000X	Hematology (Internal Medicine) Physician	An internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, cl…
207RC0000X	Cardiovascular Disease Physician	An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threaten…
2279G1100X	General Care Registered Respiratory Therapist	This level of care includes diagnostics testing, therapeutics, monitoring, rehabilitation of patients with disorders of the cardiopulmonary system, as…
111NS0005X	Sports Physician Chiropractor	A sports chiropractor is uniquely trained to provide care and treatment of injuries or illness resulting from sports and physical fitness activities. …
207WX0110X	Pediatric Ophthalmology and Strabismus Specialist Physician Physician	An ophthalmologist who specializes in pediatric ophthalmology and strabismus management. The subspecialty includes the medical and surgical management…
261QP1100X	Podiatric Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
163WC1600X	Continuing Education/Staff Development Registered Nurse	Nursing Service Providers · Registered Nurse

Related ICD-10-CM Codes

27 rows

ICD-10-CM Code	Description
A41.9	Sepsis, unspecified organism
B34.9	Viral infection, unspecified
E11.9	Type 2 diabetes mellitus without complications
E78.5	Hyperlipidemia, unspecified
F32.9	Major depressive disorder, single episode, unspecified
F41.9	Anxiety disorder, unspecified
G43.909	Migraine, unspecified, not intractable, without status migrainosus
G44.1	Vascular headache, not elsewhere classified
I20.9	Angina pectoris, unspecified
I21.4	Non-ST elevation (NSTEMI) myocardial infarction

Showing 1–10 of 27

HCPCS G9490: Home Visit Patient Assessment for Non-Homebound Beneficiary

HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

HCPCS G0008: Administration of Influenza Virus Vaccine

HCPCS-G0009-PNEUMOCOCCAL-VACCINE-ADMINISTRATION

HCPCS G0009: Administration of Pneumococcal Vaccine

HCPCS-G0010-HEPATITIS-B-VACCINE-ADMINISTRATION

HCPCS G0010: Administration of Hepatitis B Vaccine

HCPCS-G0011-PREP-COUNSELING-HIV-RISK-REDUCTION-ADHERENCE

HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment

HCPCS-G0012-PRE-EXPOSURE-PROPHYLAXIS-INJECTION-HIV-PREVENTION

HCPCS G0012: Injection of PrEP Drug for HIV Prevention

HCPCS-G0013-PREP-INDIVIDUAL-COUNSELING-HIV-RISK-REDUCTION

HCPCS G0013: Individual PrEP Counseling by Clinical Staff

HCPCS-G0017-PSYCHOTHERAPY-CRISIS-FIRST-60-MINUTES-NON-OFFICE

HCPCS G0017: Psychotherapy for Crisis, First 60 Minutes

HCPCS-G0018-PSYCHOTHERAPY-CRISIS-ADDITIONAL-30-MINUTES-NON-OFFICE

HCPCS G0018: Psychotherapy for Crisis, Additional 30 Minutes

HCPCS-G0019-COMMUNITY-HEALTH-INTEGRATION-SDOH-CARE-COORDINATION

HCPCS G0019: Community Health Integration, Person-Centered Assessment

Showing 1–10 of 1996

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99223`	Initial hospital care, typically 70 minutes or more on the first hospital inpatient encounter	Used when the patient is admitted and an extended initial inpatient face-to-face evaluation is performed after telehealth triage
`99285`	Emergency department visit for the evaluation and management of a patient with high severity, typically 40 minutes or longer	May be billed by the ED if the ED clinician provides the ED-level E/M service in conjunction with the telehealth consult
`99446`	Interprofessional telephone/Internet/electronic health record consult professional consult, 5-10 minutes of medical consultative discussion and review	Used for shorter interprofessional electronic consultations; relates when phone/e-consults supplement the telehealth consult
`99451`	Interprofessional e-consultation, physician time 5 minutes or more	Used when a consultant provides a written electronic consult without synchronous audiovisual patient interaction
`99091`	Collection and interpretation of physiologic data digitally stored and/or transmitted by the patient to the physician	May be used when remote monitoring data contribute to the telehealth consultation

Related Modifiers

5 rows

Modifier	Description	When to Use
95	Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…	- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
91	Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…	- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…
P6	Modifier P6 indicates a declared brain‑dead patient whose organs are being removed for donor purposes. It is part of the Anesthesia Physical Status Modifiers (P1–P6) and corresponds to ASA VI. The…	- When to use: Append CPT modifier P6 to anesthesia codes in the 00100–01999 range when the anesthesia provider documents a declared brain‑dead patient whose organs are being removed for donor…
[object Object]

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
2084P0800X	Psychiatry Physician	A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
207RH0000X	Hematology (Internal Medicine) Physician	An internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, cl…
207RC0000X	Cardiovascular Disease Physician	An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threaten…
2279G1100X	General Care Registered Respiratory Therapist	This level of care includes diagnostics testing, therapeutics, monitoring, rehabilitation of patients with disorders of the cardiopulmonary system, as…
111NS0005X	Sports Physician Chiropractor	A sports chiropractor is uniquely trained to provide care and treatment of injuries or illness resulting from sports and physical fitness activities. …
207WX0110X	Pediatric Ophthalmology and Strabismus Specialist Physician Physician	An ophthalmologist who specializes in pediatric ophthalmology and strabismus management. The subspecialty includes the medical and surgical management…
261QP1100X	Podiatric Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
163WC1600X	Continuing Education/Staff Development Registered Nurse	Nursing Service Providers · Registered Nurse

Related ICD-10-CM Codes

27 rows

ICD-10-CM Code	Description
A41.9	Sepsis, unspecified organism
B34.9	Viral infection, unspecified
E11.9	Type 2 diabetes mellitus without complications
E78.5	Hyperlipidemia, unspecified
F32.9	Major depressive disorder, single episode, unspecified
F41.9	Anxiety disorder, unspecified
G43.909	Migraine, unspecified, not intractable, without status migrainosus
G44.1	Vascular headache, not elsewhere classified
I20.9	Angina pectoris, unspecified
I21.4	Non-ST elevation (NSTEMI) myocardial infarction

Showing 1–10 of 27

HCPCS G9490: Home Visit Patient Assessment for Non-Homebound Beneficiary

HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

HCPCS G0008: Administration of Influenza Virus Vaccine

HCPCS-G0009-PNEUMOCOCCAL-VACCINE-ADMINISTRATION

HCPCS G0009: Administration of Pneumococcal Vaccine

HCPCS-G0010-HEPATITIS-B-VACCINE-ADMINISTRATION

HCPCS G0010: Administration of Hepatitis B Vaccine

HCPCS-G0011-PREP-COUNSELING-HIV-RISK-REDUCTION-ADHERENCE

HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment

HCPCS-G0012-PRE-EXPOSURE-PROPHYLAXIS-INJECTION-HIV-PREVENTION

HCPCS G0012: Injection of PrEP Drug for HIV Prevention

HCPCS-G0013-PREP-INDIVIDUAL-COUNSELING-HIV-RISK-REDUCTION

HCPCS G0013: Individual PrEP Counseling by Clinical Staff

HCPCS-G0017-PSYCHOTHERAPY-CRISIS-FIRST-60-MINUTES-NON-OFFICE

HCPCS G0017: Psychotherapy for Crisis, First 60 Minutes

HCPCS-G0018-PSYCHOTHERAPY-CRISIS-ADDITIONAL-30-MINUTES-NON-OFFICE

HCPCS G0018: Psychotherapy for Crisis, Additional 30 Minutes

HCPCS-G0019-COMMUNITY-HEALTH-INTEGRATION-SDOH-CARE-COORDINATION

HCPCS G0019: Community Health Integration, Person-Centered Assessment

Showing 1–10 of 1996

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

HCPCS G0425: Telehealth Consultation, Emergency or Initial Inpatient

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OpenPayer

HCPCS G0425: Telehealth Consultation, Emergency or Initial Inpatient

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

References

HCPCS G0425: Telehealth Consultation, Emergency or Initial Inpatient

Sign up for hcpcs G0425 policy alerts

HCPCS G0425: Telehealth Consultation, Emergency or Initial Inpatient

Sign up for hcpcs G0425 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What does HCPCS G0425 represent and when is it used?

What clinical workflow and activities align with billing G0425?

Which other CPT/HCPCS codes are related to G0425 and how do they relate?

What diagnoses are commonly associated with use of G0425?

Which payers are listed for G0425 and does the page provide reimbursement amounts?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What does HCPCS G0425 represent and when is it used?

What clinical workflow and activities align with billing G0425?

Which other CPT/HCPCS codes are related to G0425 and how do they relate?

What diagnoses are commonly associated with use of G0425?

Which payers are listed for G0425 and does the page provide reimbursement amounts?

References