HCPCS Code G0425: Telehealth Consultation, Emergency Department or Initial Inpatient, Typically 30 Minutes Communicating With the Patient Via Telehealth

Learn about the HCPCS code G0425 for a 30-minute telehealth consultation for the emergency department or initial inpatients.

Use Code

## **What is the HCPCS code G0425 for?** The HCPCS code G0425 is under the category of HCPCS codes called Procedures / Professional Services. This code in particular designates a telehealth consultation performed in the emergency department (ED) or during an initial inpatient encounter. These telehealth consultations last around 30 minutes. This service is delivered by a provider at a distant site, meaning they're not physically present with the patient, and it involves synchronous audio-visual communication. The goal of this type of session is to provide an evaluation, management consultation, and remote patient monitoring for acute or emergent conditions, serving as a substitute for an in-person consultation in acute care settings, thus reducing the need for immediate in-person visits, plus facilitating early interventions for the patient. Please note that this is for initial inpatients, not established patients.

## **Documentation requirements for G0425** As with any HCPCS code, you're going to need sufficient documentation that satisfies your insurer's correct coding guidelines, requirements, related policy articles, and local coverage determinations concerning telehealth reimbursements, telehealth consultations, telehealth services provided, management services, etc. Here are examples of what you'll need: - The full name of the patient - The full name and credentials of the healthcare professional who handled the patient via telehealth - The telehealth modality used (e.g., interactive audio/video, telephone services, video service) - The setting (ED or initial inpatient encounter) - Time and complexity evidence, including history, exams, and medical decision-making consistent with approximately 30 minutes of service delivery - Telemedicine services provided (if any) - Documentation of pre-, intra-, and post-service activities: review of patient data, communication with other professionals, the actual consultation, and documentation of care recommendations

## **Billing requirements for G0425** Besides the documetnation requirements above, please take note of or have the following: - One 30-minute session = 1 unit of service - You must append modifier GT (for interactive audio‐video telehealth) or GQ (for asynchronous telehealth in federally supported programs) depending on modality - Place of Service (POS): Should reflect the location where the patient is physically situated (e.g., POS 21 for inpatient hospital, POS 23 for ED). - G0425 cannot be billed in conjunction with an in-person E/M consultation for the same encounter; it replaces that service - Only one initial inpatient/ED telehealth consultation (G0425–G0427) may be billed per encounter; repeated billing for the same episode is not permissible Again, please follow the necessary articles related to your insurer (e.g., Medicare telehealth services for Medicare patients, Medicaid services).

## **Other similar codes** - **G0426** - Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth - **G0427** - Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth - **G0406** - Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth - **G0407** - Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth - **G0408** - Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth

Frequently asked questions

Select the code matching the total typical time spent in the consultation: ~30 minutes for G0425; ~50 minutes for G0426; ~70 minutes or more for G0427.

No. G0425 replaces any in-person E/M consultation. Pre-, intra-, and post-consult activities are bundled into this code; billing both would be duplicative and non-compliant.

This kind of service is faster and doesn't need travel time to get the necessary medical advice from you. However, because this relies on technology, there could be tech issues. Physical exams are limited, and you can only rely on self-reported symptoms.