G1025 HCPCS code: Patient-months where there are more than one medicare capitated payment (mcp) provider listed for the month
G1025 is the HCPCS Level II code for patient-months where there are more than one medicare capitated payment (mcp) provider listed for the month. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case.
Code details
| Field | Value |
|---|---|
| Section | G codes — Procedures and professional services (temporary) |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 00 — Not separately priced by Medicare |
| BETOS category | Z2 |
| Added | 2022-01-01 |
| Last action effective | 2022-01-01 |
What changed for G1025
- 2022-01-01: G1025 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code G1025?
G1025 is the HCPCS Level II code for patient-months where there are more than one medicare capitated payment (mcp) provider listed for the month. Short descriptor: "Pt mnth 1 mcp prov".
Does Medicare cover G1025?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Related G10 codes
- G1000 — Clinical decision support mechanism applied pathways, as defined by the medicare appropriate use criteria program
- G1001 — Clinical decision support mechanism evicore, as defined by the medicare appropriate use criteria program
- G1002 — Clinical decision support mechanism medcurrent, as defined by the medicare appropriate use criteria program
- G1003 — Clinical decision support mechanism medicalis, as defined by the medicare appropriate use criteria program
- G1004 — Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program
- G1005 — Clinical decision support mechanism national imaging associates, as defined by the medicare appropriate use criteria program
- G1006 — Clinical decision support mechanism test appropriate, as defined by the medicare appropriate use criteria program
- G1007 — Clinical decision support mechanism aim specialty health, as defined by the medicare appropriate use criteria program
- G1008 — Clinical decision support mechanism cranberry peak, as defined by the medicare appropriate use criteria program
- G1009 — Clinical decision support mechanism sage health management solutions, as defined by the medicare appropriate use criteria program
- G1010 — Clinical decision support mechanism stanson, as defined by the medicare appropriate use criteria program
- G1011 — Clinical decision support mechanism, qualified tool not otherwise specified, as defined by the medicare appropriate use criteria program
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Next steps
- Run a reimbursement report for a device billed under G1025
- Watch G1025 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G1025
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.