HCPCS G0545: Inpatient complexityMedicare rate & RVUs
Add-on for the added complexity of eligible inpatient or observation evaluation and management visits involving patients with serious or complex conditions.
Medicare pays $48.43 for G0545 nationally in the office and $40.42 in a hospital or facility. Local office rates run $44.99–$63.31.
Medicare rate · G0545
Inpatient complexity
Swap in your local Medicare rate.
- Work RVUs
- 0.89
- Total RVUs
- 1.45
- Global days
- ZZZ
National rate · 2026
$48.43
Office setting, before claim adjustments.
See every locality for G0545 → · Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 10 sections
What G0545 covers
G0545 recognizes the added work inherent in certain hospital-based evaluation and management visits for patients with serious or complex conditions. It is relevant to hospitalists, internists, and other clinicians managing these patients during an inpatient or observation stay. The primary service is the actual evaluation and management encounter; G0545 represents the additional complexity associated with that visit, not a separate patient encounter.
Report G0545 only with an eligible primary service, such as an initial or subsequent inpatient or observation care visit, when the visit meets the add-on’s requirements. Documentation should support the primary E/M service and describe the serious or complex condition and the work involved in managing it during the stay. CMS classifies G0545 as an add-on code: it is billed with a primary procedure and paid within that procedure’s global period.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where G0545 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$44.99 to $63.31
109 of 109 payment localities
G0545 rates by state
Office rate range in each state. Select a state to see its payment localities.
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Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$44.99
$63.31
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $63.31 | 1 |
| AL | $45.37 | 1 |
| AR | $44.99 | 1 |
| AZ | $47.59 | 1 |
| CA | $49.42–$57.85 | 29 |
| CO | $49.32 | 1 |
| CT | $50.78 | 1 |
| DC | $53.21 | 1 |
| DE | $48.15 | 1 |
| FL | $48.89–$52.68 | 3 |
| GA | $47.11–$49.25 | 2 |
| GU | $49.69 | 1 |
| HI | $49.69 | 1 |
| IA | $45.63 | 1 |
| ID | $45.89 | 1 |
| IL | $48.32–$51.75 | 4 |
| IN | $46.03 | 1 |
| KS | $45.70 | 1 |
| KY | $46.42 | 1 |
| LA | $46.45–$47.78 | 2 |
| MA | $49.30–$52.57 | 2 |
| MD | $48.73–$53.21 | 3 |
| ME | $46.24–$47.42 | 2 |
| MI | $47.31–$49.46 | 2 |
| MN | $47.26 | 1 |
| MO | $46.11–$47.65 | 3 |
| MS | $45.55 | 1 |
| MT | $48.43 | 1 |
| NC | $46.49 | 1 |
| ND | $47.04 | 1 |
| NE | $45.72 | 1 |
| NH | $48.81 | 1 |
| NJ | $51.35–$53.08 | 2 |
| NM | $47.54 | 1 |
| NV | $48.06 | 1 |
| NY | $46.92–$55.43 | 5 |
| OH | $47.03 | 1 |
| OK | $46.16 | 1 |
| OR | $47.67–$50.13 | 2 |
| PA | $46.96–$50.09 | 2 |
| PR | $48.58 | 1 |
| RI | $49.28 | 1 |
| SC | $46.84 | 1 |
| SD | $46.88 | 1 |
| TN | $45.86 | 1 |
| TX | $46.79–$49.43 | 8 |
| UT | $47.21 | 1 |
| VA | $47.47–$53.21 | 2 |
| VI | $48.58 | 1 |
| VT | $47.11 | 1 |
| WA | $49.13–$53.20 | 2 |
| WI | $46.13 | 1 |
| WV | $47.30 | 1 |
| WY | $47.82 | 1 |
How the G0545 rate is calculated
Each of G0545’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · G0545
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.89Practice expense 0.49Malpractice 0.07
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for G0545
The CMS indicators that decide how G0545 is paid alongside other services.
CMS payment indicators · G0545
Inpatient complexity
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
G0545 compared with similar codes
Compare codes
G0545 vs 99221 vs G2211 vs G0544: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 99221Initial hospital care
- 99221 reports the initial inpatient or observation E/M service. G0545 is an add-on for qualifying added complexity and cannot replace the primary visit code.
- G2211Visit complexity add-on
- G2211 is a complexity add-on for qualifying office or outpatient E/M visits. G0545 is associated with inpatient or observation care.
- G0544Discharge follow-up
- G0544 describes post-discharge phone follow-up; G0545 is reported with an eligible inpatient or observation visit.
G0545 billing questions
Can G0545 be billed by itself?
No. It is an add-on code and must be reported with an eligible primary service.
How is G0545 different from the primary inpatient E/M code?
The primary E/M code reports the inpatient or observation encounter. G0545 captures added complexity associated with an eligible visit for a patient with a serious or complex condition.
What documentation supports G0545?
Document the primary inpatient or observation E/M service and the serious or complex condition and management work supporting the add-on.
Is G0545 a post-discharge telephone service?
No. G0545 is associated with an inpatient or observation visit. G0544 describes a post-discharge phone follow-up service.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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