Question 1

What is HCPCS code G1025?

Accepted Answer

HCPCS code G1025 is "Pt mnth 1 mcp prov". Patient-months where there are more than one medicare capitated payment (mcp) provider listed for the month

Question 2

What category is G1025 in?

Accepted Answer

G1025 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G1025?

Accepted Answer

Use G1025 when billing for pt mnth 1 mcp prov. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is G1025 covered by Medicare?

Accepted Answer

Coverage for G1025 (Pt mnth 1 mcp prov) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for G1025?

Accepted Answer

Documentation for G1025 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).