HCPCS Code G0467: Federally Qualified Health Centers FQHC visit, established patient, a medically necessary, face-to-face encounter

## **What is HCPCS code G0467?** HCPCS code G0467 is a specific code used by Federally Qualified Health Centers (FQHCs) for billing and reimbursement. It represents a medically-necessary, face-to-face encounter between an established patient and an FQHC practitioner wherein 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 code covers a bundle of services that would typically be furnished per diem to a Medicare beneficiary.

## **G0467 documentation requirements** For the code to be billable, the documentation must support a medically necessary, face-to-face (one-on-one) encounter which includes: - Evidence of a qualifying FQHC visit - The FQHC services are medically necessary. - The FQHC services are rendered by a qualified FQHC practitioner - The patient must be an "established patient"

## **G0467 billing requirements** Key billing requirements for this code are the following: - Must be submitted using revenue code 0521 on a UB-04 claim form - All services furnished on the same day for a single patient must be reported on one claim - Follows the single encounter rule (unless the circumstance is an exception) - The FQHC is paid the lesser of the adjusted FQHC PPS rate

## **Other relevant codes** - G0468: Initial preventive physical examination (IPPE) or an Annual wellness visit (AWV) - G0469: Mental health encounter with a new patient

Frequently asked questions

G0467 is for an established patient, while G0466 is for a new patient.

No, group mental health services do not meet the criteria for a one-on-one, face-to-face encounter, which is a requirement for a G0467 visit.

Visits solely for medication management may not qualify as a billable mental health visit. The visit must be a medically-necessary, face-to-face encounter during which one or more FQHC services are rendered.