Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonHCPCS G0425 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth
| Key Fact | Detail |
|---|---|
| Service Type | Procedures / Professional Services Initial Telehealth Consultations |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for G0425 |
National average reimbursement for HCPCS G0425 by major payers:
$125.88
$127.08
$108.33
$97.98
Compare published rates across providers.
Choose a payer to see a sample of rates for HCPCS G0425.
HCPCS G0425
5 of 25 sample ratesHigher to lower in this preview
Matthew Lilley
Bend Memorial Clinic, PC
$286.50Published rateChristopher Raio
Mercy Medical Center
$166.78Published rateChristopher Raio
Mercy Medical Center
$141.54Published rateBradley Smith
Emergeortho, P.A.
$112.51Published rateGeorge Hemstreet
Bama Heart Doc, PC Dba Alabama Heart & Vascular Medicine
$103.23Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalHCPCS G0425 vs. Other Initial Telehealth Consultations Codes
The HCPCS G0425 code is part of the Procedures / Professional Services services used for Initial Telehealth Consultations. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS G0425 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| G0423-HCPCS | Low | Intensive cardiac rehabilitation; with or without continuous ECG monitoring; without exercise, per session |
| G0425-HCPCS | Low | Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth |
| G0426-HCPCS | Low | Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G0425. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G0425 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like HCPCS G0425) and we'll show you how you compare in 15 minutes or less.