HCPCS G0426 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 • Initial Telehealth Consultations |
| Complexity Level | Low |
National average reimbursement for HCPCS G0426 by major payers:
$174.82
$173.03
$149.11
$138.89
| 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 G0426 | ||||||
United | G0426 | $175.25 | 1225014657 - CAROLINA RADIOLOGY ASSOCIATES LLC | 571049603 - (SC) CAROLINA RADIOLOGY ASSOCIATES, LLC | SC | Diagnostic Radiology Physician (2085R0202X) |
United | G0426 | $214.72 | 1063741163 - AZTEC URGENT CARE, LLC | 271495988 - (NM) AZTEC URGENT CARE LLC | NM | Urgent Care Clinic/Center (261QU0200X) |
United | G0426 | $131.52 | 1386607315 - LISA FLAHERTY | 383432126 - (FL) PINELLAS MEDICAL ASSOCIATES, PA | FL | Neurology Physician (2084N0400X) |
United | G0426 | $328.04 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | G0426 | $129.10 | 1548290943 - BUFFALO REHAB GROUP PHYSICAL THERAPY AND OCCUPATIONAL THERAPY PC | 161379851 - BUFFALO REHAB GROUP | NY | Physical Therapist (225100000X) |
United | G0426 | $131.52 | 1003914284 - ANTHONY ALBERT | 383432126 - (FL) PINELLAS MEDICAL ASSOCIATES, PA | FL | Orthopaedic Surgery Physician (207X00000X) |
United | G0426 | $140.61 | 1235153883 - WILDWOOD SANITARIUM, INCORPORATED, WILDWOOD LIFESTYLE CENTER AND HOSPITAL | 586039864 - (GA) WILDWOOD SANITARIUM INCORPORATED | GA | General Acute Care Hospital (282N00000X) |
United | G0426 | $145.74 | 1396769964 - JULIE WEBSTER | 853861695 - MUSC COMMUNITY PHYSICIANS | SC | Body Imaging Physician (2085B0100X) |
United | G0426 | $204.19 | 1861615304 - THE BAXLEY AND APPLING COUNTY HOSPITAL AUTHORITY, APPLING HEALTHCARE SYSTEM | 586002659 - (GA) APPLING HOSPITAL | GA | General Acute Care Hospital (282N00000X) |
United | G0426 | $257.79 | 1306136551 - UJUKA ILOABUCHI | 582483738 | GA | Women's Hospital (282NW0100X) |
United | G0426 | $178.11 | 1033168257 - DUBLIN VAMC | 582080668 - (GA) DUBLIN VAMC | GA | General Acute Care Hospital (282N00000X) |
United | G0426 | $234.53 | 1194779702 - JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC. | 580566121 - JOHN D ARCHBOLD MEMORIAL HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | G0426 | $313.13 | 1073502985 - CHU CHEN | 42484572 | MA | Pediatrics Physician (208000000X) |
United | G0426 | $117.98 | 1225014657 - CAROLINA RADIOLOGY ASSOCIATES LLC | 571049603 - (SC) CAROLINA RADIOLOGY ASSOCIATES, LLC | SC | Diagnostic Radiology Physician (2085R0202X) |
United | G0426 | $111.06 | 1619087590 - MIGUEL ARENAS | 300394179 - (AZ) MIGUEL A ARENAS MD PC | AZ | Gastroenterology Physician (207RG0100X) |
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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
HCPCS G0426 vs. Other Initial Telehealth Consultations Codes
The HCPCS G0426 code is part of the Procedures / Professional Services services used for Initial Telehealth Consultations. 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 G0426 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 |
|---|---|---|
| G0425-HCPCS | Low | Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth |
| G0426-HCPCS | Low | Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth |
| G0427-HCPCS | Moderate | Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more 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 G0426. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G0426 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like HCPCS G0426) and we'll show you how you compare in 15 minutes or less.