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    v1.0.31
    OpenPayerBilling CodesProcedures / Professional ServicesHCPCS hcpcs-g0459-inpatient-telehealth-pharmacologic-management
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    HCPCS G0459: Inpatient Telehealth Pharmacologic Management

    Medicare pays $41 on average nationally for this procedure.

    HCPCS Level II code G0459 describes inpatient telehealth pharmacologic management, covering remote evaluation and management of medication prescribing, use, and review with no more than minimal medical psychotherapy; service type is telehealth pharmacologic management and the typical site of service is inpatient setting via telehealth.

    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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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 62-year-old hospitalized patient with a history of major depressive disorder and chronic obstructive pulmonary disease is admitted for acute exacerbation and worsening depressive symptoms. The inpatient psychiatric consult team arranges a telehealth pharmacologic management visit while the inpatient psychiatrist is offsite. Via a secure, hospital-approved audiovisual connection, the psychiatrist reviews the patient’s current medications, assesses for medication efficacy and adverse effects, reconciles home and inpatient meds, prescribes initiation of an antidepressant with dosing guidance, and documents brief supportive counseling limited to no more than minimal medical psychotherapy. The encounter focuses on medication selection, dosing, monitoring plan, and coordination with the primary inpatient team and nursing for administration and safety monitoring.

    Clinical workflow:

    • The primary team requests psychiatric pharmacologic management; the consult service schedules a telehealth visit.

    • Pre-visit chart review of history, labs, current medications, allergies, and prior psychiatric treatments is completed.

    • A secure telehealth connection is established from the hospital inpatient unit to the psychiatrist at a remote location.

    • The psychiatrist conducts the interview, documents medication decisions, issues electronic prescriptions or orders to the inpatient pharmacy, and arranges follow-up monitoring.

    • The provider documents time, informed consent for telehealth if required, and any communication with the inpatient team in the medical record.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99221Initial hospital inpatient care, typically 30 minutes at bedsidePerformed when the admitting physician provides the initial comprehensive inpatient evaluation prior to or alongside telehealth psychiatric pharmacologic management.
    99231Subsequent hospital inpatient care, typically 15 minutesUsed for in-person daily follow-up by the primary team; complements telehealth psychiatric medication follow-up when billed separately.
    90833Psychotherapy with evaluation and management services, crisis or ongoing, with E/M; 30 minutesMay be reported when brief psychotherapy beyond minimal medical psychotherapy is furnished in addition to pharmacologic management, subject to payer rules.
    99406Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutesMay be provided as an adjunct behavioral counseling service during the inpatient stay related to medication effects or risk reduction.
    99497Advance care planning including explanation and discussion of advance directive(s)May be provided in complex inpatient cases where medication decisions are part of broader goals-of-care discussions; billed separately if performed and documented.

    Related Modifiers

    7 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…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207Q00000X
    2084P0800X
    207R00000X
    208D00000X
    363L00000X
    227800000X
    207ZM0300X
    242T00000X

    Related ICD-10-CM Codes

    24 rows

    ICD-10-CM CodeDescription
    E11.9Type 2 diabetes mellitus without complications
    E66.9Obesity, unspecified
    F10.20Alcohol dependence, uncomplicated
    F11.20Opioid dependence, uncomplicated
    F12.20Cannabis dependence, uncomplicated
    F19.20Other psychoactive substance dependence, uncomplicated
    F20.9Schizophrenia, unspecified
    F31.9Bipolar disorder, unspecified
    F32.9Major depressive disorder, single episode, unspecified
    F33.1Major depressive disorder, recurrent, moderate

    Showing 1–10 of 24

    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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