G0421 Ed svc ckd grp per session

Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour

Medically Unlikely Edits (effective October 1, 2026)

Medicare pricing for G0421

Physician Fee Schedule (CY 2026, RVU26D)

Status A: active, paid separately under the PFS if covered. National amounts: non-facility $27.39, facility $27.39 (total RVUs 0.82 / 0.82 × $33.4009 conversion factor; facility NA: rarely or never done in that setting). Work RVU 0.50, practice expense RVU 0.29 non-facility and 0.29 facility, malpractice RVU 0.03. Global period XXX. Qualifying APM participants are paid at a $33.5675 conversion factor.

Payer policies and prior authorization for G0421

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • LA: $23.06 (professional), effective Sep 8, 2023
  • ND: $0.00 (physician), effective Aug 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.