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New CPT codes for FQHC claims


In compliance with the statutory requirements of the Affordable Care Act, Centers for Medicare & Medicaid Services (CMS) released five specific payment codes to be used by FQHCs submitting claims under the PPS. These codes helps track Federal Quality Health Center (FQHC) visits and are paid at all-inclusive rate per visit for qualified primary and preventive health services. 

The New Codes are;

1. G0466 – FQHC visit, new patient

A medically-necessary, face to face encounter (one-on-one) between a new patient and a FQHC practitioner during which time one or more FQHC services are rendered and includes a typical bundle of Medicare-covered services that would be furnished per diem to a patient receiving a FQHC visit

2. G0467 – FQHC visit, established patient

A medically-necessary, face to face encounter (one-on-one) between an established patient and a FQHC practitioner during which time one or more FQHC services are rendered and includes a typical bundle of Medicare-covered services that would be furnished per diem to a patient receiving a FQHC visit

3. G0468 – FQHC visit, IPPE or AWV

A FQHC visit that includes an Initial Preventive Physical Examination (IPPE) or Annual Wellness Visit (AWV) and includes a typical bundle of Medicare-covered services that would be furnished per diem to a patient receiving an IPPE or AWV

4. G0469 – FQHC visit, mental health, new patient

A medically-necessary, face-to-face mental health encounter (one-on-one) between a new patient and a FQHC practitioner during which time one or more FQHC services are rendered and includes a typical bundle of Medicare covered services that would be furnished per diem to a patient receiving a mental health visit

5. G0470 – FQHC visit, mental health, established patient

A medically-necessary, face-to-face mental health encounter (one-on-one) between an established patient and a FQHC practitioner during which time one or more FQHC services are rendered and includes a typical bundle of Medicare covered services that would be furnished per diem to a patient receiving a mental health visit

Reference: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM8743.pdf

See also complete list of CPT code Changes for CY 2015

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