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    OpenPayerBilling CodesProcedures / Professional ServicesHCPCS hcpcs-g0425-telehealth-ed-initial-inpatient-30min-consult
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    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.

    For related coverage guidance, see recent payer policy updates: Achalasia and Gastroesophageal Reflux Disease (GERD) - Minimally Invasive Procedures - Medical Policy, Esophageal Brush Biopsy, Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disorders.

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

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    95Modifier 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…
    26Modifier 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…
    91Modifier 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…
    P6Modifier 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…
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    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    2084P0800X
    207RH0000X
    207RC0000X
    2279G1100X
    111NS0005X
    207WX0110X
    261QP1100X
    163WC1600X

    Related ICD-10-CM Codes

    27 rows

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

    Showing 1–10 of 27

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    10 rows

    PolicyPayerEffective Date
    Achalasia and Gastroesophageal Reflux Disease (GERD) - Minimally Invasive Procedures - Medical PolicyHealth-New-England2027-02-01
    Esophageal Brush Biopsycaresourcegeorgia2026-12-01
    Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disordersbcbsvermont2026-12-01
    Gastric Pacing/Gastric Electrical Stimulation (GES)Cigna2026-11-15
    Percutaneous Electrical Nerve Field Stimulation for Disorders of Gut-Brain Interactionpremerabluecrossofwashington2026-11-06
    Percutaneous electrical nerve field stimulation for disorders of gut-brain interactionpremerabluecrossofwashington2026-11-06
    Percutaneous Electrical Nerve Field Stimulation for Disorders of Gut-Brain Interactionpremerabluecrossofwashington2026-11-06
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Non-invasive Testing for Liver FibrosisModa Health2026-11-01
    Surgical Site of Care - Colonoscopy and Sigmoidoscopyregence2026-11-01

    Related Codes

    HCPCS-G9490-HOME-ASSESSMENT-NON-HOMEBOUND

    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

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    Frequently Asked Questions

    References

    1. 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. 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. 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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