HCPCS Level II › G codes G0257 Unsched dialysis esrd pt hosUnscheduled or emergency dialysis treatment for an esrd patient in a hospital outpatient department that is not certified as an esrd facility
Medicare coverage: Special coverage instructions apply Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 0 units per day (clinical), rationale: CMS Policy Outpatient hospital: max 1 units per day (clinical), rationale: Nature of Service/Procedure Medicare pricing for G0257 Physician Fee Schedule (CY 2026, RVU26D) Status E: excluded from the PFS by regulation.
Payer policies and prior authorization for G0257 Medicaid fee-for-service Prior authorization required or conditional in IN.
AZ: $474.40 (outpatient_hospital), effective Oct 1, 2021 IL: $35.75 (practitioner), effective Jul 1, 2026 ND: $0.00 (physician), effective Aug 1, 2026 VT: $532.90 (outpatient_hospital_opps), effective Feb 1, 2026 WY: $303.51 (outpatient_hospital_apc, Ambulatory Surgical Centers), effective Apr 1, 2026 From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.