G0406 Inpt/tele follow up 15

Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth

Medically Unlikely Edits (effective October 1, 2026)

Medicare pricing for G0406

Physician Fee Schedule (CY 2026, RVU26D)

Status A: active, paid separately under the PFS if covered. National amounts: non-facility $36.07, facility $36.07 (total RVUs 1.08 / 1.08 × $33.4009 conversion factor; non-facility NA: rarely or never done in that setting). Work RVU 0.76, practice expense RVU 0.24 non-facility and 0.24 facility, malpractice RVU 0.08. Global period XXX. Qualifying APM participants are paid at a $33.5675 conversion factor.

Payer policies and prior authorization for G0406

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • LA: $36.55 (professional), effective Sep 8, 2023
  • ND: $38.68 (physician), effective Aug 1, 2026
  • NY: $29.75 (physician_medicine, facility), effective Jul 1, 2026
  • OH: $30.94 (physician), effective Mar 9, 2020
  • TX: $27.89 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Sep 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), 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.