HCPCS G0250
Md inr test revie inter mgmt
Status R Special coverage instructions apply, so whether Medicare pays depends on the circumstances of the service. Full definition → HCPCS Level II Restricted — special coverage instructions mean payability depends on the circumstances.
Where this amount comes from
- Physician relative value file (PPRRVU) CMS download page PPRRVU17_OCT.csv in rvu17d.zip · row 1,431 hcpcs = G0250 (col 1) · status_code = R (col 4) · work_rvu = 0.18 (col 6) · pe_rvu_nonfacility = 0.07 (col 7) · pe_rvu_facility = 0.07 (col 9) · mp_rvu = 0.01 (col 11)
- Physician relative value file (PPRRVU) CMS download page PPRRVU17_OCT.csv in rvu17d.zip · row 11 conversion_factor = 35.8887 (col 25)
(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor
= (0.18 × 1.000 + 0.07 × 1.000 + 0.01 × 1.000) × $35.8887 = $9.33
How much did Medicare pay for HCPCS G0250 in Q4 2017? Copy link
Medicare paid $9.33 for HCPCS G0250 in the office (non-facility) setting and $9.33 in a facility under the Q4 2017 Physician Fee Schedule, effective October 2017. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. Across payment localities, both settings' amount is $8.81–$12.74. This price has been unchanged since Q1 2017, when it increased 0.2%.
Source: Physician relative value file (Q4 2017) · effective October 2017 · materially updated Aug 4, 2026 · compact facts
Why isn't there a national PFS amount?
- Status R (Restricted): Special coverage instructions apply, so whether Medicare pays depends on the circumstances of the service.
CMS evidence · 2 sources
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Rates by locality Copy link
The amounts above use GPCI 1.000, a national baseline no locality actually bills at. Medicare rescales every code by the local Geographic Practice Cost Indices before paying it, so what G0250 pays depends on where the service is furnished. Tap a state for its localities.
G0250 non-facility rate by metro area
Highest-paying metro first. Each figure is that payment locality's own GPCI-adjusted amount.
Queens, NY
$10.58
Long Island, NY
$10.56
San Jose, CA
$10.55
San Francisco, CA
$10.52
New York City, NY
$10.35
Washington, DC
$10.25
Northern New Jersey, NJ
$10.06
Los Angeles, CA
$9.99
Miami, FL
$9.96
Boston, MA
$9.86
Chicago, IL
$9.85
Baltimore, MD
$9.81
Philadelphia, PA
$9.79
Seattle, WA
$9.78
Suburban Chicago, IL
$9.76
Fort Lauderdale, FL
$9.66
San Diego, CA
$9.57
Riverside, CA
$9.55
Sacramento, CA
$9.55
Detroit, MI
$9.49
Houston, TX
$9.46
Portland, OR
$9.42
New Orleans, LA
$9.39
Dallas, TX
$9.38
Austin, TX
$9.29
Fort Worth, TX
$9.26
Kansas City, MO
$9.24
St. Louis, MO
$9.24
G0250 facility rate by metro area
Highest-paying metro first. Each figure is that payment locality's own GPCI-adjusted amount.
Queens, NY
$10.58
Long Island, NY
$10.56
San Jose, CA
$10.55
San Francisco, CA
$10.52
New York City, NY
$10.35
Washington, DC
$10.25
Northern New Jersey, NJ
$10.06
Los Angeles, CA
$9.99
Miami, FL
$9.96
Boston, MA
$9.86
Chicago, IL
$9.85
Baltimore, MD
$9.81
Philadelphia, PA
$9.79
Seattle, WA
$9.78
Suburban Chicago, IL
$9.76
Fort Lauderdale, FL
$9.66
San Diego, CA
$9.57
Riverside, CA
$9.55
Sacramento, CA
$9.55
Detroit, MI
$9.49
Houston, TX
$9.46
Portland, OR
$9.42
New Orleans, LA
$9.39
Dallas, TX
$9.38
Austin, TX
$9.29
Fort Worth, TX
$9.26
Kansas City, MO
$9.24
St. Louis, MO
$9.24
Q4 2017 amounts, computed with each locality's own GPCIs, before the ~2% sequestration cut. A state with more than one payment locality shows a range — its tile is colored by the mean across those localities, which is a shading choice, not an amount anyone is paid.
How this amount is computed Copy link
HCPCS G0250 has a work RVU of 0.18, a non-facility practice expense RVU of 0.07, a facility practice expense RVU of 0.07 and a malpractice RVU of 0.01 — for total non-facility RVUs of 0.26 and total facility RVUs of 0.26 in the Q4 2017 release.
amount = (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × conversion factor. National amounts use GPCI = 1.000. To price an RVU figure of your own, use the RVU-to-dollars converter.
| Component | RVU |
|---|---|
| Work RVU | 0.18 |
| Practice expense RVU (non-facility) | 0.07 |
| Practice expense RVU (facility) | 0.07 |
| Malpractice RVU | 0.01 |
Every rate combines three parts: work (the clinician’s time, skill and effort), practice expense (office overhead — higher when the service is done in a doctor’s own office), and malpractice (the share of liability-insurance cost). A blank means CMS publishes no national number for that part. Read it as unknown, and never as zero.
What does G0250 cost? Copy link
Four numbers get called the cost of a code. Each answers a different question.
Computed from the Q4 2017 CMS release
- Medicare allowed amount
- $9.33
- Medicare's share
- $7.46
- Patient coinsurance
- $1.87
- Limiting charge
- $10.19
What Medicare recognizes as the full price for G0250 in the office (non-facility) setting. Every figure below derives from it.
80% of the allowed amount, before the ~2% sequestration cut.
The remaining 20%, once the annual Part B deductible is met. Medigap or Medicaid often covers it.
The ceiling a non-participating provider can bill a patient on an unassigned claim — 109.25% of the allowed amount.
National Q4 2017 figures at GPCI 1.000. Adjust for your locality and sequestration, or see the questions below for each figure in full.
Common questions Copy link
Is $9.33 what a practice actually receives?
It's the national allowed amount — the starting point. Medicare pays 80% of it ($7.46) and the patient owes 20% coinsurance ($1.87). Sequestration trims Medicare's share by about 2%, your locality's GPCIs scale the total up or down, and the expected-payment calculator applies all three. What lands is practice revenue: staff, space, equipment and billing, not clinician take-home pay. The practice-expense RVU above is CMS's estimate of that overhead share.
Sources: Budget Control Act sequestration provisions; CMS Medicare Fee-for-Service payment guidance; CMS Geographic Practice Cost Index (GPCI) files; CMS Physician Fee Schedule overview (cms.gov).
What's the non-participating amount for G0250?
$8.86 in the office (non-facility) setting — 95% of the $9.33 participating fee schedule amount above. A participating provider takes the fee schedule amount as payment in full on every claim. A non-participating provider is paid this reduced amount, but chooses claim by claim whether to accept assignment. See participating vs non-participating.
Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.
What's the limiting charge for G0250?
$10.19 in the office (non-facility) setting — the ceiling on what a non-participating provider can bill the patient on an unassigned claim. That's 109.25% of the $9.33 amount above. The non-participating amount is 95% of the fee schedule rate ($8.86), and the statutory cap is 115% of that. See limiting charge.
Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.
Why would a Medicare claim for G0250 be denied or paid less?
These come from CMS indicators on this page, not general billing advice.
- Its status indicator is R (restricted) — Special coverage instructions apply, so whether Medicare pays depends on the circumstances of the service. See status indicators
- Only a professional component exists for G0250 — there is no technical-component amount to bill. See billing policy
- Bilateral surgery: no bilateral adjustment. See billing policy
- Assistant at surgery: restricted without documentation. See billing policy
- Co-surgeons: not permitted. See billing policy
- Team surgery: not permitted. See billing policy
Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. The G0250 rate last moved in Q1 2026 (+7.3% non-facility) — see its rate history or what changed each release, or get an email when a new release moves rates.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
Applicable payment rules Copy link
Only the rules that can matter for G0250, each linking to its detail on this page.
Global period: what G0250's fee already covers Copy link
The global surgery concept does not apply to this code.
| Modifier | Reports |
|---|---|
| -25 | A significant, separately identifiable E/M on the same day as the procedure, beyond its usual pre- and post-operative care. |
A modifier reports what happened; it does not by itself make a service payable. Documentation has to support it.
Billing policy Copy link
What G0250's billing-policy indicators mean. These show for every code, priced or not: a restriction like "bilateral not allowed" still matters on a carrier-priced code. See modifier amounts below for the dollar figures these support.
| Policy | Value | What it means |
|---|---|---|
| Bilateral surgery | 0 | No bilateral adjustment. The 150% bilateral payment adjustment does not apply to this procedure. |
| Assistant at surgery | 0 | Restricted without documentation. Payment for an assistant at surgery is restricted for this procedure unless supporting documentation establishes medical necessity. |
| Co-surgeons | 0 | Not permitted. Medicare does not recognize co-surgeons (modifier 62) for this procedure. |
| Team surgery | 0 | Not permitted. Medicare does not recognize a surgical team (modifier 66) for this procedure. |
| Multiple procedures | 0 | No reduction. No payment reduction applies when this procedure is billed with other procedures on the same date — each is treated as unrelated. |
| Professional/technical split | 2 | Professional component only. Only a professional component exists for this code — there is no corresponding technical-component amount to bill. |
Modifier amounts: -26/TC, -50, -80/81/82, -AS, -62, -66 Copy link
National non-facility amounts for the modifiers this code's indicators support. Single-line modifiers only. -51 (multiple-procedure reduction) depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one. Use the calculator for a locality-adjusted, sequestration-aware amount.
| Modifier | What it means | Amount |
|---|---|---|
| -26/TC | Professional/technical split | Not payable |
| -50 | Bilateral procedure | Not payable |
| -80/81/82 | Assistant surgeon (physician) | Not payable |
| -AS | Assistant at surgery (PA, NP, or CNS) | Not payable |
| -62 | Co-surgeons, each | Not payable |
| -66 | Team surgery | Not payable |
These apply standard MPFS percentages — assistant surgeon 16%, co-surgeon 62.5%, bilateral 150% — to the national non-facility amount above, so its source citation covers them too. They are derived here rather than read from a CMS column: check them against the current Medicare Claims Processing Manual before relying on them for payment.
Can you bill it with another code? Copy link
Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit between it and G0250.
Rate history by release Copy link
National non-facility amount for G0250 across quarterly releases. -3.1% decrease since Q2 2014 · high $9.38 in Q1 2020
| Release | Status | Non-facility | Facility |
|---|---|---|---|
| Q3 2026 Jul 1, 2026 – present | R | $9.02 (0.0% no change ) | $9.02 (0.0% no change ) |
| Q2 2026 Apr 1, 2026 – Jun 30, 2026 | R | $9.02 (0.0% no change ) | $9.02 (0.0% no change ) |
| Q1 2026 Jan 1, 2026 – Mar 31, 2026 | R | $9.02 (+7.3% increase ) | $9.02 (+7.3% increase ) |
| Q4 2025 Oct 1, 2025 – Dec 31, 2025 | R | $8.41 (0.0% no change ) | $8.41 (0.0% no change ) |
| Q3 2025 Jul 1, 2025 – Sep 30, 2025 | R | $8.41 (0.0% no change ) | $8.41 (0.0% no change ) |
| Q2 2025 Apr 1, 2025 – Jun 30, 2025 | R | $8.41 (0.0% no change ) | $8.41 (0.0% no change ) |
| Q1 2025 Jan 1, 2025 – Mar 31, 2025 | R | $8.41 (-2.8% decrease ) | $8.41 (-2.8% decrease ) |
| Q4 2024 Oct 1, 2024 – Dec 31, 2024 | R | $8.65 (0.0% no change ) | $8.65 (0.0% no change ) |
| Q3 2024 Jul 1, 2024 – Sep 30, 2024 | R | $8.65 (0.0% no change ) | $8.65 (0.0% no change ) |
| Q2 2024 Apr 1, 2024 – Jun 30, 2024 | R | $8.65 (0.0% no change ) | $8.65 (0.0% no change ) |
| Q1 2024 Jan 1, 2024 – Mar 31, 2024 | R | $8.65 (-1.8% decrease ) | $8.65 (-1.8% decrease ) |
| Q4 2023 Oct 1, 2023 – Dec 31, 2023 | R | $8.81 (0.0% no change ) | $8.81 (0.0% no change ) |
| Q3 2023 Jul 1, 2023 – Sep 30, 2023 | R | $8.81 (0.0% no change ) | $8.81 (0.0% no change ) |
| Q2 2023 Apr 1, 2023 – Jun 30, 2023 | R | $8.81 (0.0% no change ) | $8.81 (0.0% no change ) |
| Q1 2023 Jan 1, 2023 – Mar 31, 2023 | R | $8.81 (+6.0% increase ) | $8.81 (+6.0% increase ) |
| Q4 2022 Oct 1, 2022 – Dec 31, 2022 | R | $8.31 (0.0% no change ) | $8.31 (0.0% no change ) |
| Q3 2022 Jul 1, 2022 – Sep 30, 2022 | R | $8.31 (0.0% no change ) | $8.31 (0.0% no change ) |
| Q2 2022 Apr 1, 2022 – Jun 30, 2022 | R | $8.31 (0.0% no change ) | $8.31 (0.0% no change ) |
| Q1 2022 Jan 1, 2022 – Mar 31, 2022 | R | $8.31 (+3.5% increase ) | $8.31 (+3.5% increase ) |
| Q4 2021 Oct 1, 2021 – Dec 31, 2021 | R | $8.03 (0.0% no change ) | $8.03 (0.0% no change ) |
| Q3 2021 Jul 1, 2021 – Sep 30, 2021 | R | $8.03 (0.0% no change ) | $8.03 (0.0% no change ) |
| Q2 2021 Apr 1, 2021 – Jun 30, 2021 | R | $8.03 (0.0% no change ) | $8.03 (0.0% no change ) |
| Q1 2021 Jan 1, 2021 – Mar 31, 2021 | R | $8.03 (-14.4% decrease ) | $8.03 (-14.4% decrease ) |
| Q4 2020 Oct 1, 2020 – Dec 31, 2020 | R | $9.38 (0.0% no change ) | $9.38 (0.0% no change ) |
| Q3 2020 Jul 1, 2020 – Sep 30, 2020 | R | $9.38 (0.0% no change ) | $9.38 (0.0% no change ) |
| Q2 2020 Apr 1, 2020 – Jun 30, 2020 | R | $9.38 (0.0% no change ) | $9.38 (0.0% no change ) |
| Q1 2020 Jan 1, 2020 – Mar 31, 2020 | R | $9.38 (+0.1% increase ) | $9.38 (+0.1% increase ) |
| Q4 2019 Oct 1, 2019 – Dec 31, 2019 | R | $9.37 (0.0% no change ) | $9.37 (0.0% no change ) |
| Q3 2019 Jul 1, 2019 – Sep 30, 2019 | R | $9.37 (0.0% no change ) | $9.37 (0.0% no change ) |
| Q2 2019 Apr 1, 2019 – Jun 30, 2019 | R | $9.37 (0.0% no change ) | $9.37 (0.0% no change ) |
| Q1 2019 Jan 1, 2019 – Mar 31, 2019 | R | $9.37 (+0.1% increase ) | $9.37 (+0.1% increase ) |
| Q4 2018 Oct 1, 2018 – Dec 31, 2018 | R | $9.36 (0.0% no change ) | $9.36 (0.0% no change ) |
| Q3 2018 Jul 1, 2018 – Sep 30, 2018 | R | $9.36 (0.0% no change ) | $9.36 (0.0% no change ) |
| Q2 2018 Apr 1, 2018 – Jun 30, 2018 | R | $9.36 (0.0% no change ) | $9.36 (0.0% no change ) |
| Q1 2018 Jan 1, 2018 – Mar 31, 2018 | R | $9.36 (+0.3% increase ) | $9.36 (+0.3% increase ) |
| Q4 2017 Oct 1, 2017 – Dec 31, 2017 | R | $9.33 (0.0% no change ) | $9.33 (0.0% no change ) |
| Q3 2017 Jul 1, 2017 – Sep 30, 2017 | R | $9.33 (0.0% no change ) | $9.33 (0.0% no change ) |
| Q2 2017 Apr 1, 2017 – Jun 30, 2017 | R | $9.33 (0.0% no change ) | $9.33 (0.0% no change ) |
| Q1 2017 Jan 1, 2017 – Mar 31, 2017 | R | $9.33 (+0.2% increase ) | $9.33 (+0.2% increase ) |
| Q4 2016 Oct 1, 2016 – Dec 31, 2016 | R | $9.31 (0.0% no change ) | $9.31 (0.0% no change ) |
| Q3 2016 Jul 1, 2016 – Sep 30, 2016 | R | $9.31 (0.0% no change ) | $9.31 (0.0% no change ) |
| Q2 2016 Apr 1, 2016 – Jun 30, 2016 | R | $9.31 (0.0% no change ) | $9.31 (0.0% no change ) |
| Q1 2016 Jan 1, 2016 – Mar 31, 2016 | R | $9.31 (-0.3% decrease ) | $9.31 (-0.3% decrease ) |
| Q4 2015 Oct 1, 2015 – Dec 31, 2015 | R | $9.34 (+0.4% increase ) | $9.34 (+0.4% increase ) |
| Q3 2015 Jul 1, 2015 – Sep 30, 2015 | R | $9.30 (0.0% no change ) | $9.30 (0.0% no change ) |
| Q2 2015 Apr 1, 2015 – Jun 30, 2015 | R | $9.30 (0.0% no change ) | $9.30 (0.0% no change ) |
| Q1 2015 Jan 1, 2015 – Mar 31, 2015 | R | $9.30 (-0.1% decrease ) | $9.30 (-0.1% decrease ) |
| Q4 2014 Oct 1, 2014 – Dec 31, 2014 | R | $9.31 (0.0% no change ) | $9.31 (0.0% no change ) |
| Q3 2014 Jul 1, 2014 – Sep 30, 2014 | R | $9.31 (0.0% no change ) | $9.31 (0.0% no change ) |
| Q2 2014 Apr 1, 2014 – Jun 30, 2014 | R | $9.31 | $9.31 |
Contracted rate: % of Medicare Copy link
Commercial payer contracts usually price off the Medicare amount above ("BCBS pays 115% of Medicare"). Enter your contract's percentage below to see what G0250 pays at that rate — $9.33 is 100%.
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Source & method
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This is computed from CMS's Medicare Physician Fee Schedule Q4 2017 release (schedule pfs, effective October 2017). National amounts apply a GPCI of 1.000 and leave sequestration off. The status indicator decides payability, never the RVU values, so a blank RVU stays blank. Releases are immutable: a rate retrieved for a past quarter always reflects that release. CMS owns the code description shown for HCPCS Level II codes. Modifier amounts apply standard MPFS percentages to this code's billing indicators. We derive them here rather than read them from CMS, so confirm them against the current Claims Processing Manual before relying on them for payment. Our methodology covers the depth: sourcing, parsing, versioning, and how we cross-check claims before they ship.
Conversion factor $35.8887 read from the same file, row 11, column 25.
Use the (i) buttons next to each amount above for the exact row, columns, and math.
Cite this rate
This link keeps pointing at the Q4 2017 figures, even after a newer release lands.
HCPCS G0250 Medicare Physician Fee Schedule rate: $9.33 (Q4 2017). Localis. https://localishealth.com/hcpcs/G0250/2017/D