How To Use HCPCS Code G0470

HCPCS code G0470 describes a federally qualified health center (FQHC) visit for mental health services provided to an established patient. This code is used to identify a medically-necessary, face-to-face mental health encounter between the 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 G0470?

HCPCS code G0470 is specifically used to identify a mental health visit provided by a federally qualified health center (FQHC) to an established patient. It is important to note that this code is only applicable for face-to-face encounters and should not be used for telehealth or other non-face-to-face services. The purpose of this code is to accurately document and bill for the mental health services provided by an FQHC.

2. Official Description

The official description of HCPCS code G0470 is as follows: “Federally qualified health center (FQHC) visit, mental health, established patient; a medically-necessary, face-to-face mental health 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 a mental health visit.” The short description for this code is “FQHC visit, mh estab pt.”

3. Procedure

1. Before providing the mental health visit, the FQHC practitioner should review the patient’s medical history and any relevant documentation.
2. During the face-to-face encounter, the FQHC practitioner should engage in a one-on-one conversation with the established patient to assess their mental health needs.
3. The practitioner should provide appropriate mental health services based on the patient’s needs, which may include counseling, therapy, or other interventions.
4. Throughout the visit, the FQHC practitioner should document the services provided, including any assessments, treatments, or referrals made.
5. After the visit, the FQHC practitioner should ensure that all necessary documentation is completed and accurately reflects the services rendered during the mental health visit.

4. When to use HCPCS code G0470

HCPCS code G0470 should be used when an established patient receives a face-to-face mental health visit at a federally qualified health center (FQHC). It is important to note that this code is only applicable for established patients and should not be used for new patients. Additionally, this code should only be used for medically-necessary mental health encounters and not for routine check-ups or other non-mental health related visits.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0470, healthcare providers should ensure that the following documentation requirements are met:

• Documentation of the patient’s established status with the FQHC
• Documentation of the face-to-face encounter between the patient and the FQHC practitioner
• Documentation of the mental health services provided during the visit
• Documentation of any assessments, treatments, or referrals made
• Documentation of any Medicare-covered services included in the bundle

Providers should also follow the appropriate billing guidelines and submit the claim with the necessary supporting documentation to ensure accurate reimbursement for the services provided.

6. Historical Information and Code Maintenance

HCPCS code G0470 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. It is important for medical coders and billers to stay updated on any changes or revisions to this code to ensure accurate coding and billing practices.

7. Medicare and Insurance Coverage

HCPCS code G0470 is eligible for Medicare coverage. The pricing indicator code for this code is 13, which means that the price is established by carriers. This indicates that the reimbursement for this code may vary depending on the carrier’s determination. The multiple pricing indicator code for this code is A, which means it is not applicable as HCPCS is priced under one methodology. It is important for healthcare providers to verify coverage and reimbursement policies with Medicare and other insurance carriers to ensure accurate billing and reimbursement for the services provided.

8. Examples

Here are five examples of scenarios where HCPCS code G0470 should be billed:

1. An established patient visits an FQHC for a one-on-one counseling session with a mental health practitioner.
2. An established patient receives therapy services for the management of their mental health condition at an FQHC.
3. An established patient with a diagnosed mental health disorder visits an FQHC for a medication management session with a healthcare provider.
4. An established patient receives a comprehensive mental health assessment at an FQHC to determine the appropriate treatment plan.
5. An established patient with a history of substance abuse seeks counseling services at an FQHC to address their mental health needs.