Consumption-oriented or efficiency-oriented, it is a hard choice for the green technology innovation pathway. This paper uses the intermediary model to empirically analyze the panel data from 250 prefecture-level cities in China from 2010 to 2019. The conclusions show that: 1. At present, energy consumption-oriented green technology innovation at the national level in China shows a completely intermediary effect, which has a more obvious emission reduction effect; compared with energy consumption, energy efficiency-oriented green technology innovation only has a very weak intermediary effect of 6.58%. 2. Only the Eastern non-resource cities and the Midwest resource cities’ green technology innovation have the effect of energy efficiency-oriented emission reduction, accounting for 8.11% and 9.02%, respectively. 3. Both the Eastern resource cities and the Midwest non-resource cities have no intermediary effect on energy efficiency, so carbon emission reduction is more difficult than in other cities.