How To Use HCPCS Code G0469

HCPCS code G0469 describes a federally qualified health center (FQHC) visit for mental health services provided to a new patient. This code is used to identify a medically-necessary, face-to-face mental health encounter between a new patient and an FQHC practitioner. During this encounter, one or more FQHC services are rendered, and it includes a typical bundle of Medicare-covered services that would be furnished per diem to a patient receiving a mental health visit.

1. What is HCPCS G0469?

HCPCS code G0469 is specifically used to identify a new patient visit to a federally qualified health center for mental health services. It is important to note that this code is only applicable for FQHC visits and cannot be used for other types of healthcare facilities or providers.

2. Official Description

The official description of HCPCS code G0469 is as follows: “Federally qualified health center (FQHC) visit, mental health, new patient; a medically-necessary, face-to-face mental health 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 a mental health visit.” The short description for this code is “FQHC visit, mh new pt.”

3. Procedure

1. The FQHC practitioner schedules an appointment for a new patient seeking mental health services.
2. During the appointment, the practitioner conducts a face-to-face encounter with the patient.
3. The practitioner provides one or more FQHC services as part of the mental health visit.
4. The services rendered may include counseling, therapy, medication management, or other appropriate interventions.
5. The duration of the visit may vary depending on the patient’s needs and the services provided.

4. When to use HCPCS code G0469

HCPCS code G0469 should be used when a new patient visits a federally qualified health center for a mental health encounter. It is important to ensure that the encounter is medically necessary and that the patient meets the criteria for receiving FQHC services. This code is not applicable for established patients or for visits to other types of healthcare providers.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0469, healthcare providers need to document the details of the mental health visit, including the services provided, the duration of the encounter, and any relevant patient information. It is important to follow the documentation guidelines set forth by Medicare or other insurance carriers to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G0469 was added to the Healthcare Common Procedure Coding System on October 01, 2014. As of now, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. It is important for medical coders and billers to stay updated on any changes or revisions to HCPCS codes to ensure accurate coding and billing practices.

7. Medicare and Insurance Coverage

HCPCS code G0469 is payable by Medicare and other insurance carriers. The pricing indicator code 13 indicates that the price for this code is established by carriers, meaning it is not otherwise classified and is determined on an individual basis. The multiple pricing indicator code A indicates that the code is not applicable as HCPCS priced under one methodology. It is important to verify coverage and reimbursement policies with the specific insurance carrier to ensure proper billing and reimbursement.

8. Examples

Here are five examples of scenarios where HCPCS code G0469 should be billed:

1. A new patient visits an FQHC for an initial mental health evaluation and receives counseling services during the encounter.
2. A patient with a newly diagnosed mental health condition seeks treatment at an FQHC and receives medication management services during the visit.
3. A child with behavioral issues is brought to an FQHC for a mental health assessment and receives therapy services during the appointment.
4. A patient with a history of substance abuse seeks help at an FQHC and receives individual counseling and group therapy services during the visit.
5. An individual experiencing a mental health crisis visits an FQHC for immediate intervention and receives crisis counseling and referral services.