HCPCS G0259 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Procedures / Professional Services • Miscellaneous Diagnostic and Therapeutic Services |
| Complexity Level | Low |
National average reimbursement for HCPCS G0259 by major payers:
$129.16
$54.94
$132.66
$84.72
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS G0259 | ||||||
United | G0259 | $2476.00 | 1962435792 - HOUSTON HOSPITALS INC, HOUSTON MEDICAL CENTER | 711045290 - (GA) HOUSTON HOSPITALS INC | GA | General Acute Care Hospital (282N00000X) |
United | G0259 | $723.00 | 1649488511 - TOURO INFIRMARY ANESTHESIA SERVICES | 720423659 - (LA) TOURO INFIRMARY | LA | General Acute Care Hospital (282N00000X) |
United | G0259 | $1856.00 | 1780643411 - PIEDMONT MOUNTAINSIDE HOSPITAL, INC., PIEDMONT MOUNTAINSIDE HOSPITAL | 352228583 - (GA) PIEDMONT MOUNTAINSIDE HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | G0259 | $479.00 | 1356860621 - CHI MEMORIAL HOSPITAL | 822748395 - CHI MEMORIAL HOSPITAL - GEORGIA | GA | General Acute Care Hospital (282N00000X) |
United | G0259 | $1488.00 | 1588640692 - EMORY UNIVERSITY, EMORY UNIVERSITY HOSPITAL | 580566200 | GA | General Acute Care Hospital (282N00000X) |
United | G0259 | $1550.00 | 1922530468 - SOUTHEAST GEORGIA HEALTH SERVICES, L.L.C., MEMORIAL SATILLA HEALTH | 814223395 | GA | Rural Acute Care Hospital (282NR1301X) |
United | G0259 | $1265.00 | 1588640692 - EMORY UNIVERSITY, EMORY UNIVERSITY HOSPITAL | 580566200 | GA | General Acute Care Hospital (282N00000X) |
United | G0259 | $343.00 | 1689736282 - THE HOSPITAL AUTHORITY OF HABERSHAM COUNTY | 922451946 | GA | Rural Acute Care Hospital (282NR1301X) |
United | G0259 | $1737.00 | 1225034333 - PIEDMONT HENRY HOSPITAL, INC. | 582200195 - (GA) PIEDMONT HENRY HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | G0259 | $1737.00 | 1528027240 - FAYETTE COMMUNITY HOSPITAL, INC., PIEDMONT FAYETTE HOSPITAL | 582322328 - (GA) FAYETTE COMMUNITY HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | G0259 | $1473.00 | 1992799050 - GRADY MEMORIAL HOSPITAL CORPORATION, GRADY HEALTH SYSTEMS | 262037695 - GRADY MEMORIAL HOSPITAL CORPORATION | GA | General Acute Care Hospital (282N00000X) |
United | G0259 | $695.00 | 1730761065 - BURKE HOSPITAL COMPANY, BURKE HEALTH | 853939331 - BURKE HOSPITAL COMPANY, LLC | GA | General Acute Care Hospital (282N00000X) |
United | G0259 | $363.00 | 1548471337 - TATTNALL COMMUNITY HOSPITAL, TATTNALL COMMUNITY HOSPITAL | 300466706 | GA | Critical Access Hospital (282NC0060X) |
United | G0259 | $145.00 | 1912627712 - CENTER FOR ROBOTIC SURGERY OF LOUISIANA LLC | 883537315 - CENTER FOR ROBOTIC SURGERY OF LOUISIANA LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | G0259 | $699.00 | 1710914734 - MEMORIAL HOSPITAL OF WASHINGTON COUNTY, WASHINGTON COUNTY REGIONAL MEDICAL CENTER & ECF | 586012329 - (GA) HOSPITAL AUTHORITY OF WASHINGTON COUNTY | GA | Rural Acute Care Hospital (282NR1301X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS G0259 vs. Other Miscellaneous Diagnostic and Therapeutic Services Codes
The HCPCS G0259 code is part of the Procedures / Professional Services services used for Miscellaneous Diagnostic and Therapeutic Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS G0259 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| G0257-HCPCS | Moderate | Unscheduled or emergency dialysis treatment for an ESRD patient in a hospital outpatient department that is not certified as an ESRD facility |
| G0259-HCPCS | Low | Injection procedure for sacroiliac joint; arthrograpy |
| G0260-HCPCS | Moderate | Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G0259. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G0259 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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