How To Use HCPCS Code G0467

HCPCS code G0467 describes a federally qualified health center (FQHC) visit for an established patient. This code is used to identify a medically-necessary, face-to-face encounter between the 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 G0467?

HCPCS code G0467 is specifically used to identify FQHC visits for established patients. 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 G0467 is “Federally qualified health center (FQHC) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established 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, estab pt.”

3. Procedure

1. The FQHC practitioner schedules an appointment with the established patient.
2. During the visit, the practitioner conducts a face-to-face encounter with the patient.
3. One or more FQHC services are rendered to the patient during the encounter.
4. The practitioner provides the necessary medical care and services as required by the patient’s condition.
5. The visit may include various Medicare-covered services that are typically provided per diem to patients receiving FQHC visits.

4. When to use HCPCS code G0467

HCPCS code G0467 should be used when an established patient visits an FQHC and receives medically-necessary services. It is important to ensure that the patient meets the criteria for an FQHC visit and that the services provided are within the scope of FQHC services. This code should not be used for other types of healthcare visits or encounters.

5. Billing Guidelines and Documentation Requirements

When billing for an FQHC visit using HCPCS code G0467, healthcare providers need to ensure that the necessary documentation is in place. This includes documenting the face-to-face encounter, the specific FQHC services rendered, and any additional Medicare-covered services provided during the visit. The documentation should support the medical necessity of the services and the eligibility of the patient for an FQHC visit.

6. Historical Information and Code Maintenance

HCPCS code G0467 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. This code remains in use to identify FQHC visits for established patients.

7. Medicare and Insurance Coverage

HCPCS code G0467 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 the code is not applicable as HCPCS priced under one methodology. It is important to check with other insurers to determine their coverage and pricing policies for FQHC visits using this code.

8. Examples

Here are five examples of scenarios where HCPCS code G0467 should be billed:

1. An established patient visits an FQHC for a routine check-up and receives various FQHC services during the visit.
2. An established patient with a chronic condition visits an FQHC for a follow-up appointment and receives necessary medical care and services.
3. An established patient visits an FQHC for a mental health counseling session and receives the appropriate FQHC services during the visit.
4. An established patient visits an FQHC for a preventive screening and receives the necessary FQHC services as part of the visit.
5. An established patient visits an FQHC for a minor injury and receives the required medical care and services during the visit.