$26.80
G0420 is for education delivered to one patient; G0421 is for education delivered to a group.
On this page
CMS RVU26D · Effective 2026-10-01
G0420 Kidney disease education Medicare reimbursement rates in Vermont
Reports an individual kidney disease education session for a patient with stage IV chronic kidney disease, focused on managing disease and treatment choices. Compare G0420 office and facility rates across CMS payment localities in Vermont.
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 G0420 in Vermont?
Vermont 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
$111.03
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
Facility setting
No supported rate
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.
Patient education
About G0420: Individual chronic kidney disease education session
Reports an individual kidney disease education session for a patient with stage IV chronic kidney disease, focused on managing disease and treatment choices.
G0420 represents face-to-face education delivered to one patient with chronic kidney disease. A qualified kidney disease educator may cover steps to slow disease progression, nutrition and medication management, and choices such as dialysis, transplantation, or conservative care. The education is intended for patients with stage IV CKD and is commonly provided in an outpatient setting after physician referral.
Report one session for the individual format, not for education delivered to a group. The record should identify the patient’s CKD education need, topics addressed, and the individual service provided. Medicare’s kidney disease education benefit allows up to six sessions for eligible beneficiaries. Use G0421 when the session is delivered to a group. The CMS facts supplied list no special payment rule for this code.
Where the value comes from
- Work RVU2.12 · 62%
- Practice expense (office) RVU1.15 · 34%
- Malpractice RVU0.13 · 4%
5.9K
Medicare services in 2024 · #1771 by national volume
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.
G0420 compared with similar codes
Office rates for Vermont, from the same CMS release.
98960
No office rateEdu&trn pt self-mgmt nqhp 1
98960 describes individual self-management education more generally. G0420 is the kidney disease education code for the Medicare CKD benefit.
98961
No office rateEdu&trn pt slf-mgmt nqhp 2-4
98961 is a general small-group self-management education code. For a group session specifically addressing CKD under the kidney disease education benefit, use G0421.
Compare G0420 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
Vermont →
Office / nonfacility
$111.03
Facility
Unavailable
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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 G0420 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
15,248
- Code
- G0420
- Physician work
- 2.12
- Practice expense
- 1.15
- Malpractice
- 0.13
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.12 | × 1.000 | 2.1200 |
| Practice expense | 1.15 | × 0.990 | 1.1385 |
| Malpractice | 0.13 | × 0.506 | 0.0658 |
| Total RVUs | 3.3243 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$111.03
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.12 | 1 |
| Practice expense | 1.15 | 0.99 |
| Malpractice | 0.13 | 0.506 |
(2.12 × 1 + 1.15 × 0.99 + 0.13 × 0.506) × $33.4009 = $111.03
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.
G0420 billing questions
When should G0420 be used instead of G0421?
Use G0420 when education is delivered individually to one patient. G0421 is for a group session.
How many sessions may Medicare cover?
The Medicare kidney disease education benefit allows up to six sessions for eligible beneficiaries with stage IV CKD.
What documentation supports G0420?
Document the patient’s CKD education need, the individual session provided, and the subjects addressed, such as disease management or treatment options.
Can G0420 be reported for a group class?
No. G0420 describes individual education; use G0421 for a group session.
Does G0420 include a separately billed professional or technical component?
The supplied CMS facts identify no professional or technical component for G0420. Report the individual education session as a whole.
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.
15,245G0416,,"Prostate biopsy, any mthd",A,,3.51,7.06,,7.06,NA,0.11,10.68,10.68,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,246G0416,26,"Prostate biopsy, any mthd",A,,3.51,1.44,,1.44,,0.06,5.01,5.01,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,247G0416,TC,"Prostate biopsy, any mthd",A,,0.00,5.62,,5.62,NA,0.05,5.67,5.67,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,248G0420,,Ed svc ckd ind per session,A,,2.12,1.15,,1.15,NA,0.13,3.40,3.40,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,249G0421,,Ed svc ckd grp per session,A,,0.50,0.29,,0.29,NA,0.03,0.82,0.82,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,250G0422,,Intens cardiac rehab w/exerc,A,,2.05,1.77,,1.77,,0.12,3.94,3.94,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,251G0423,,Intens cardiac rehab no exer,A,,2.05,1.77,,1.77,,0.12,3.94,3.94,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817