Federally qualified health center 'G' codes
FQHCs must use the codes below when submitting claims to Medicare under the FQHC PPS. Be sure to maintain records of the services and charges associated with each 'G' code.
- G0466 – FQHC visit, new patient
A medically necessary medical, or a qualified preventive health, face-to-face encounter (one-on-one) between a new patient, and a 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 FQHC visit.
- G0467 – FQHC visit, established patient
A medically necessary medical, or a qualifying preventive health, face-to-face encounter (one-on-one) between an established patient and a 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 FQHC visit
- G0468 – FQHC visit, IPPE or AWV
A FQHC visit that includes an initial preventive physical exam (IPPE) or annual wellness visit (AWV) and includes a typical bundle of Medicare-covered services that would be furnished per diem to a patient receiving an IPPE or AWV.
- G0469– FQHC visit, mental health, new patient
A medically necessary, face-to-face mental health encounter (one-on-one) between a new patient, and a 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.
- G0470 – 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.
- G0511 - General care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directly by an FQHC practitioner (physician, NP, PA, or CNM), per calendar month. (Effective January 1, 2018)
- G0512 - Psychiatric collaborative care model (psychiatric CoCM), 60 minutes or more of clinical staff time for psychiatric CoCM services directed by an FQHC practitioner (physician, NP, PA or CNM) and including service furnished by a behavioral health care manager and consultation with a psychiatric consultant, per calendar month. (Effective January 1, 2018)
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