Question 1

What is HCPCS code G0469?

Accepted Answer

HCPCS code G0469 is "Fqhc visit, mh new pt". 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 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

Question 2

What category is G0469 in?

Accepted Answer

G0469 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G0469?

Accepted Answer

Use G0469 when billing for fqhc visit, mh new pt. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is G0469 covered by Medicare?

Accepted Answer

Coverage for G0469 (Fqhc visit, mh new pt) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for G0469?

Accepted Answer

Documentation for G0469 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).