G0491 – Dialysis procedure at a medicare certified esrd facility for acute kidney injury without esrd

HCPCS Level II code · G codes: Procedures / Professional Services (Temporary)

Active code Carrier judgment

HCPCS codeG0491
Long description
Dialysis procedure at a medicare certified esrd facility for acute kidney injury without esrd
Short description
Dialysis acu kidney no esrd
Pricing indicator
13 Priced by the Medicare contractor (carrier)
Medicare coverage
C Carrier judgment – coverage decided by the Medicare contractor
BETOS category
P9A Dialysis services (Medicare fee schedule)
Added
January 1, 2017
Last change
January 1, 2017 – No change

Frequently asked questions

What is HCPCS code G0491?

G0491 is a HCPCS Level II code for dialysis procedure at a medicare certified esrd facility for acute kidney injury without esrd.

Does Medicare cover G0491?

The HCPCS file lists coverage code C: Carrier judgment – coverage decided by the Medicare contractor. Coverage and payment also depend on local coverage determinations and the patient’s plan.

Nearby G codes

Source: CMS HCPCS Level II quarterly file, October 2026. Reference only – check payer policy before billing.