Retroactive Rate Adjustment for HCPCS Code G2025 for FQHC and RHC Claims

Gloryanne Bryant, RHIA, CDIP, CCS, CCDS Medical Coding Leave a Comment

Retroactive Rate Adjustment for HCPCS Code G2025 for FQHC and RHC Claims

An issue was identified with the payment and cost sharing calculations on code G2025. Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) Claims with HCPCS code G2025 have been mass adjusted to correct the payment problem. Medicare Administrative Contractors (MACs) are reprocessing Federally Qualified Health Center and Rural Health Clinic claims with HCPCS code G2025 (payment for a telehealth distant site service furnished by a RHC or FQHC only).

Updated the national rate to $99.45

Provider/Supplier Type(s) Impacted: TOB 77x and 71x

No provider action is needed to correct the claims. Providers should follow the regular process for paying any overpayments on the claims that processed in error.

This information applies to:
  • JJ Part A//Federally Qualified Health Center
  • JJ Part A//Rural Health Clinic
  • JJ Part A//General
  • JM Part A//Federally Qualified Health Center
  • JM Part A//General
  • JM Part A//Rural Health Clinic

Effective January 27, 2020, CMS established new HCPCS code G2025 which is recognized for payment for a telehealth distant site service furnished by a RHC or FQHC. This code has been assigned to status indicator “A” retroactive to January 27, 2020, in the July OPPS Addendum B.

Visit Palmetto site at: Palmetto GBA - JM Part A - FQHC and RHC Claims: Retroactive Rate Adjustment for HCPCS Code G2025

Visit Noridian site at: Alerts Details - JF Part A - Noridian (noridianmedicare.com)

NOTE: The Secretary of Health and Human Services extended the nationwide public health emergency due to COVID-19 through April 20, 2021.

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