HCPCS G0423 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 • Cardiac and Pulmonary Rehabilitation Services |
| Complexity Level | Low |
National average reimbursement for HCPCS G0423 by major payers:
$136.88
$118.98
$113.84
$137.97
| 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 G0423 | ||||||
United | G0423 | $65.37 | 1033168257 - DUBLIN VAMC | 582080668 - (GA) DUBLIN VAMC | GA | General Acute Care Hospital (282N00000X) |
United | G0423 | $55.02 | 1790715381 - NORTHSIDE HOSPITAL, INC., NORTHSIDE HOSPITAL DULUTH | 582002413 | GA | General Acute Care Hospital (282N00000X) |
United | G0423 | $170.44 | 1821017831 - BACON COUNTY HEALTH SERVICES, INC, BACON COUNTY RURAL HEALTH CLINIC | 582224545 - (GA) BACON COUNTY HEALTH SERVICES INC | GA | Rural Acute Care Hospital (282NR1301X) |
United | G0423 | $114.91 | 1396769964 - JULIE WEBSTER | 853861695 - MUSC COMMUNITY PHYSICIANS | SC | Body Imaging Physician (2085B0100X) |
United | G0423 | $199.88 | 1396520862 - LAKE SURGICAL HOSPITAL SLIDELL, LLC | 474228147 - (LA) LAKE SURGICAL HOSPITAL SLIDELL, LLC DBA SOUTHERN SURGICAL HOSPITAL | LA | General Acute Care Hospital (282N00000X) |
United | G0423 | $254.92 | 1073502985 - CHU CHEN | 42484572 | MA | Pediatrics Physician (208000000X) |
United | G0423 | $265.10 | 1578568481 - SLIDELL MEMORIAL HOSPITAL, ST TAMMANY PARISH HOSPITAL SERVICE DISTRICT #2 | 726014895 - (LA) SLIDELL MEMORIAL HOSPITAL | LA | General Acute Care Hospital (282N00000X) |
United | G0423 | $110.06 | 1508900101 - MICHAEL KOCH | 208418894 - (GA) PATHOLOGY LAB OF GEORGIA LLC | GA | General Acute Care Hospital (282N00000X) |
United | G0423 | $267.98 | 1710992433 - HOSPITAL AUTHORITY OF JEFFERSON COUNTY AND THE CITY OF LOUISVILLE, JEFFERSON HOSPITAL | 581309961 - (GA) HOSPITAL AUTHORITY OF JEFFERSON COUNTY AND THE CITY OF LOUISVILLE | GA | General Acute Care Hospital (282N00000X) |
United | G0423 | $88.44 | 1619087590 - MIGUEL ARENAS | 300394179 - (AZ) MIGUEL A ARENAS MD PC | AZ | Gastroenterology Physician (207RG0100X) |
United | G0423 | $226.86 | 1225281603 - EMORY CRAWFORD LONG HOSPITAL | 581537752 - EMORY UNIVERSITY | GA | General Acute Care Hospital (282N00000X) |
United | G0423 | $59.79 | 1225014657 - CAROLINA RADIOLOGY ASSOCIATES LLC | 571049603 - (SC) CAROLINA RADIOLOGY ASSOCIATES, LLC | SC | Diagnostic Radiology Physician (2085R0202X) |
United | G0423 | $355.20 | 1689744450 - ARTHUR M. BLANK HOSPITAL, INC., ARTHUR M. BLANK HOSPITAL | 582147112 - (GA) CHILDRENS HEALTHCARE OF ATLANTA INC | GA | Children's Hospital (282NC2000X) |
United | G0423 | $198.50 | 1730110826 - EVANS MEMORIAL HOSPITAL, INC. | 582257925 - (GA) EVANS MEMORIAL HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | G0423 | $120.80 | 1457345910 - BRADLEY SMITH | 561079264 - EMERGEORTHO, P.A. | NC | Orthopaedic Surgery Physician (207X00000X) |
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 G0423 vs. Other Cardiac and Pulmonary Rehabilitation Services Codes
The HCPCS G0423 code is part of the Procedures / Professional Services services used for Cardiac and Pulmonary Rehabilitation 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 G0423 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 |
|---|---|---|
| G0422-HCPCS | Low | Intensive cardiac rehabilitation; with or without continuous ECG monitoring with exercise, per session |
| G0423-HCPCS | Low | Intensive cardiac rehabilitation; with or without continuous ECG monitoring; without exercise, per session |
| G0425-HCPCS | Low | Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G0423. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G0423 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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