How To Use HCPCS Code G0468

HCPCS code G0468 describes a federally qualified health center (FQHC) visit that includes an initial preventive physical examination (IPPE) or annual wellness visit (AWV). This code is used to identify a specific bundle of Medicare-covered services that would be furnished per diem to a patient receiving an IPPE or AWV.

1. What is HCPCS G0468?

HCPCS code G0468 is used to identify a FQHC visit that includes an IPPE or AWV. It is important to note that this code is specific to FQHC visits and should not be used for other types of visits or services.

2. Official Description

The official description of HCPCS code G0468 is “Federally qualified health center (FQHC) visit, IPPE or AWV.” The short description for this code is “FQHC visit, IPPE or AWV.”

3. Procedure

1. When performing a FQHC visit with an IPPE or AWV, the healthcare provider should first assess the patient’s medical history and perform a physical examination.
2. During the visit, the provider should also conduct a review of the patient’s risk factors and update their medical record accordingly.
3. The provider should then provide appropriate counseling and education to the patient based on their individual needs and risk factors.
4. Additionally, the provider should perform any necessary screenings or tests as part of the IPPE or AWV.
5. Finally, the provider should document all services provided during the visit and submit the appropriate claim using HCPCS code G0468.

4. When to use HCPCS code G0468

HCPCS code G0468 should be used when a patient receives a FQHC visit that includes an IPPE or AWV. It is important to ensure that all the necessary components of the IPPE or AWV are included in the visit to accurately use this code.

5. Billing Guidelines and Documentation Requirements

When billing for a FQHC visit with an IPPE or AWV using HCPCS code G0468, healthcare providers should ensure that the following documentation requirements are met:

• Documentation of the patient’s medical history and physical examination
• Documentation of the review of risk factors and updates to the medical record
• Documentation of counseling and education provided to the patient
• Documentation of any screenings or tests performed as part of the IPPE or AWV

Providers should also follow the appropriate billing guidelines set forth by Medicare or other insurers when submitting claims for reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G0468 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 G0468 is payable by Medicare. The pricing indicator code for this code is 13, which means that the price is established by carriers. The multiple pricing indicator code is A, indicating that it is not applicable as HCPCS priced under one methodology.

8. Examples

Here are five examples of when HCPCS code G0468 should be billed:

1. A patient visits a federally qualified health center for their annual wellness visit, which includes a comprehensive physical examination, review of risk factors, and counseling on preventive services.
2. A Medicare beneficiary receives an initial preventive physical examination at a federally qualified health center, which includes a medical history review, physical examination, and counseling on preventive services.
3. A patient visits a federally qualified health center for their annual wellness visit, during which the provider performs necessary screenings and tests, updates the patient’s medical record, and provides counseling on health promotion and disease prevention.
4. A Medicare beneficiary receives an initial preventive physical examination at a federally qualified health center, where the provider reviews the patient’s medical history, performs a physical examination, and provides counseling on appropriate preventive services based on the patient’s risk factors.
5. A patient visits a federally qualified health center for their annual wellness visit, which includes a comprehensive physical examination, review of risk factors, and counseling on lifestyle modifications to improve their overall health.