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See a sample rate comparisonHCPCS G0426 Fee Schedule
Last Verified: September 2026
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.
Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth
| Key Fact | Detail |
|---|---|
| Service Type | Procedures / Professional Services Initial Telehealth Consultations |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for G0426 |
National average reimbursement for HCPCS G0426 by major payers:
$174.82
$173.03
$149.11
$138.89
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HCPCS G0426
5 of 25 sample ratesHigher to lower in this preview
Jacob Holloway
$410.82Published rateMichael Guillette
Aztec Urgent Care LLC
$245.52Published rateThe Hospital Authority Of Monroe County, Georgia, Monroe County Hospital
The Hospital Authority Of Monroe County Georgia
$197.21Published rateWildwood Sanitarium, Incorporated, Wildwood Lifestyle Center And Hospital
Wildwood Sanitarium Incorporated
$140.61Published rateMiguel Arenas
Miguel A Arenas Md PC
$111.06Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS 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.
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