MDHHS has updated the billing requirements for G2025
Effective Jan. 27, 2020, clinics billing G2025 Medicaid and dual eligible (Medicare/Medicaid) claims without the clinical payment codes (G-codes and T-codes) and the accompany clinical qualifying visit codes will need to resubmit with appropriate information and a frequency of 7 to receive Medicaid payment.
What do I need to know?
Resubmit any G2025 claims sent since Jan. 27, 2020 with appropriate information and a frequency of 7 to receive Medicaid payment.
Clinics must bill clinical payment codes and the accompany clinic qualifying visit code with G2025 to receive MDHHS payment for Medicaid and dual eligible (Medicare/Medicaid) members receiving telehealth distant services.
While the Center for Medicare and Medicaid Services (CMS) is not requiring the use of clinical payment codes and clinical qualifying visit codes for Medicare only members, claims sent to Medicaid for dual eligible members with G2025 listed as the stand alone HCPCS code will not pay.
We recognize some of the claims that need to be resubmitted are over a year old, that's why our claims department is implementing a process to override timely filing when G2025 is billed. This will prevent those claims from denying.
Why are we making this change?
On Jun. 15, 2021, Michigan Department of Health and Human Services (MDHHS) announced that they are allowing rural health clinics (RHCs), federally qualified health centers (FQHCs) and tribal health centers (THCs) the use of HCPCS G2025 to provide distant site telehealth services to Medicaid members effective Jan. 27, 2020 through the end of the COVID-19 public health emergency.