No office rate
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.
On this page
CMS RVU26D · Effective 2026-10-01
G0545 Inpatient complexity Medicare reimbursement rates in Rhode Island
Add-on for the added complexity of eligible inpatient or observation evaluation and management visits involving patients with serious or complex conditions. Compare G0545 office and facility rates across CMS payment localities in Rhode Island.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for G0545 in Rhode Island?
Rhode Island has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$49.28
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
Facility setting
$41.00
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Hospital evaluation and management
About G0545: Inpatient visit complexity add-on
Add-on for the added complexity of eligible inpatient or observation evaluation and management visits involving patients with serious or complex conditions.
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.
CMS billing rules for G0545
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
Where the value comes from
- Work RVU0.89 · 61%
- Practice expense (office) RVU0.49 · 34%
- Malpractice RVU0.07 · 5%
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.
G0545 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
$17.69
G2211 is a complexity add-on for qualifying office or outpatient E/M visits. G0545 is associated with inpatient or observation care.
$68.22
G0544 describes post-discharge phone follow-up; G0545 is reported with an eligible inpatient or observation visit.
Compare G0545 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Rhode Island →
Office / nonfacility
$49.28
Facility
$41.00
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for G0545 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
15,340
- Code
- G0545
- Physician work
- 0.89
- Practice expense
- 0.49
- Malpractice
- 0.07
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.89 | × 1.019 | 0.9069 |
| Practice expense | 0.49 | × 1.033 | 0.5062 |
| Malpractice | 0.07 | × 0.892 | 0.0624 |
| Total RVUs | 1.4755 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Rhode Island$49.28
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.89 | 1.019 |
| Practice expense | 0.49 | 1.033 |
| Malpractice | 0.07 | 0.892 |
(0.89 × 1.019 + 0.49 × 1.033 + 0.07 × 0.892) × $33.4009 = $49.28
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.89 | 1.019 |
| Practice expense | 0.25 | 1.033 |
| Malpractice | 0.07 | 0.892 |
(0.89 × 1.019 + 0.25 × 1.033 + 0.07 × 0.892) × $33.4009 = $41.00
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
15,337G0542,,No pt prsnt train add 15,A,,0.54,0.24,,0.09,,0.00,0.78,0.63,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,338G0543,,Group train w/o patient,A,,0.23,0.42,,0.04,,0.01,0.66,0.28,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,339G0544,,Post d/c phone follow up,A,,0.98,0.95,,0.24,,0.07,2.00,1.29,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,340G0545,,Inherent visit to inpt,A,,0.89,0.49,,0.25,,0.07,1.45,1.21,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,341G0546,,Phone/internet ehr assess,A,,0.35,0.18,,0.09,,0.04,0.57,0.48,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,342G0547,,Phone/internet svs 11-20 m,A,,0.70,0.36,,0.19,,0.07,1.13,0.96,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,343G0548,,Phone/inter svs 21-30 m,A,,1.05,0.56,,0.29,,0.09,1.70,1.43,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537