Summary & Overview
HCPCS G0426: Telehealth Consultation, ED or Initial Inpatient (~50 minutes)
HCPCS Level II code G0426 represents a telehealth consultation conducted in the emergency department or as an initial inpatient consultation, typically lasting about 50 minutes. This code captures time-based, synchronous telehealth encounters used to evaluate and manage patients when clinicians provide consultation remotely in acute care settings. Nationally, telehealth consultation codes have grown in importance as health systems expand virtual acute care workflows and payers refine coverage and payment policies for remote evaluation services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of clinical context for telehealth consultations in acute settings, common billing and documentation considerations, and where to look for payer policy differences. The publication summarizes typical use cases for G0426, outlines expected service lines and sites of service, and indicates which stakeholders commonly engage these codes in practice.
This summary provides clinicians, billing professionals, and policy analysts a national-level orientation to G0426, including what the code represents, the primary clinical settings in which it applies, and the payer landscape that governs reimbursement and coverage. Data not available in the input are noted where relevant in the full publication.
Billing Code Overview
HCPCS Level II code G0426 describes a telehealth consultation performed in the emergency department or as an initial inpatient consultation. The service is typically a 50-minute synchronous telehealth encounter during which a clinician communicates with the patient via telehealth to evaluate, manage, or provide consultation on the patient’s condition.
Service type: Telehealth consultation
Typical site of service: Emergency department or initial inpatient setting
Clinical & Coding Specifications
Clinical Context
A patient presents to the emergency department or is newly admitted to the hospital with an acute medical concern requiring specialty evaluation. The treating team requests a telehealth consultation from an on-call specialist (for example, a hospitalist, cardiologist, neurologist, or psychiatrist) who is remote and provides a comprehensive evaluation by real-time interactive audio-video connection. The consultation typically lasts about 50 minutes and includes review of the ED or inpatient history, medications, physical exam findings as reported by the bedside clinician, diagnostic data (labs, imaging), assessment, and management recommendations documented in the medical record. The workflow: the ED/inpatient clinician contacts the telehealth service; the telehealth specialist joins via secure telehealth platform; the specialist documents the consultation, communicates recommendations to the treating team, and documents time and modality. This service is billed when the telehealth specialist provides an initial or emergency department-level consult that meets the typical time and complexity for a 50-minute encounter and is consistent with facility and payer telehealth policies.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
95 | Synchronous telemedicine service rendered via real-time interactive audio and video | Use when the service is provided through an interactive audio-video telecommunication system and payer accepts 95 for telehealth. |