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Telehealth (G2025) Coinsurance and Reimbursement Policy Updated
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12/7/2020 @ 5:16:00 PM
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Contributor: Nathan Baugh, National Association of Rural Health Clinics

Dear RHC Community,

The MLN Matters SE20016 was recently updated in a way that significantly alters G2025 reimbursement policy. The updated section is as follows:

Telehealth Services with Cost-Sharing

For the CPT and HCPCS codes included in the list of telehealth codes at the link above, we’ll
adjust the coinsurance and payment calculation for distant site telehealth services you furnished
to reflect the method used to calculate coinsurance and payment under the PFS. The
coinsurance for these services will be 20% of the lesser of the allowed amount ($92.03) or
actual charges, and the payment will be 80% of the lesser of the allowed amount ($92.03) or the
actual charges.

Before the adjustment, the coinsurance for distant site services you furnished was 20% of the
actual charges and the payment was the allowed amount ($92.03) minus the coinsurance.

MACs will automatically reprocess any claims with HCPCS code G2025 for services
furnished on or after January 27, 2020 through November 16, 2020 that were paid before
we updated the claims processing system to pay HCPCS code G2025 based on the
“lesser of” methodology, as described above.

The above language is the exact language from CMS. Unless your G2025 charges were always exactly $92.03, adjustments are coming.

We have also inquired with CMS as to when they will be announcing the update G2025 rate for 2021 and will be sure to post when we have that confirmed. 


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