How To Use HCPCS Code G0466

HCPCS code G0466 describes a federally qualified health center (FQHC) visit for a new patient. This code is used to identify a medically-necessary, face-to-face encounter between a new patient and an FQHC practitioner, during which one or more FQHC services are rendered. The visit includes a typical bundle of Medicare-covered services that would be furnished per diem to a patient receiving an FQHC visit.

1. What is HCPCS G0466?

HCPCS code G0466 is specifically used to identify a new patient visit at a federally qualified health center (FQHC). It is important to note that this code is only applicable for FQHC visits and should not be used for other types of healthcare encounters.

2. Official Description

The official description of HCPCS code G0466 is as follows: “Federally qualified health center (FQHC) visit, new patient; a medically-necessary, face-to-face encounter (one-on-one) between a new patient and an 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 an FQHC visit.” The short description for this code is “FQHC visit new patient.”

3. Procedure

1. The FQHC practitioner schedules an appointment for a new patient.
2. During the visit, the practitioner conducts a face-to-face encounter with the new patient.
3. One or more FQHC services are rendered during the encounter.
4. The practitioner provides a typical bundle of Medicare-covered services that would be furnished per diem to a patient receiving an FQHC visit.

4. When to use HCPCS code G0466

HCPCS code G0466 should be used when a new patient visits an FQHC and receives one or more FQHC services. It is important to ensure that the encounter is medically necessary and meets the criteria for an FQHC visit. This code should not be used for established patients or for visits to non-FQHC facilities.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0466, healthcare providers need to document the details of the visit, including the face-to-face encounter with the new patient, the FQHC services rendered, and the typical bundle of Medicare-covered services provided. It is important to follow the specific documentation guidelines set forth by Medicare and other payers to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G0466 was added to the Healthcare Common Procedure Coding System on October 01, 2014. Since its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code G0466 is payable by Medicare. The pricing indicator code 13 indicates that the price for this code is established by carriers, based on carrier discretion. The multiple pricing indicator code A indicates that this code is not applicable as HCPCS priced under one methodology. It is important to check with individual insurance providers to determine coverage and reimbursement rates for this code.

8. Examples

Here are five examples of when HCPCS code G0466 should be billed:

1. A new patient visits an FQHC for a comprehensive medical examination, including laboratory tests and preventive services.
2. A new patient with a chronic condition visits an FQHC for ongoing management and monitoring of their condition.
3. A new patient visits an FQHC for mental health counseling and therapy.
4. A new patient visits an FQHC for prenatal care and related services.
5. A new patient visits an FQHC for dental services, including cleanings and fillings.