Five G Codes Effective Oct. 1

Five G Codes Effective Oct. 1

The Centers for Medicare & Medicaid Services (CMS) released six new HCPCS Level II G codes, five of which became effective Oct. 1. The codes helps track federal quality health center (FQHC) visits. FQHCs are paid an all-inclusive rate per visit for qualified primary and preventive health services. Except for initial preventive physical examination (IPPE), diabetes self management training, or medical nutrition therapy, all preventive services furnished on the same day as another medical visit constitute a single billable visit.  If a visit occurs on the same day as another billable visit, both visits may be billed.

The new codes helping to define these are:

G0466      A medically-necessary, 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     A medically-necessary, 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    A FQHC visit that includes an Initial Preventive Physical Examination (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     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    A medically-necessary, face-to-face mental health 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 mental health visit

G codes are  are national codes assigned by CMS to identify professional healthcare procedures and services that may not have assigned CPT® codes. Sometimes codes are added retroactively, as in the case of this sixth code, effective April 1, 2014:

G0471     Collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (SNF) or by a laboratory on behalf of a home health agency (HHA)

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Brad Ericson

Brad Ericson

Publisher at AAPC
Brad Ericson, MPC, CPC, COSC, has been publisher for more than nine years. Before AAPC he was at Optum for 13 years and at Aetna Health Plans before that. He has been writing and publishing about healthcare since 1979. He received his Bachelor's in Journalism from Idaho State University and his Master's of Professional Communication degree from Westminster College of Salt Lake City.
Brad Ericson

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Brad Ericson, MPC, CPC, COSC, has been publisher for more than nine years. Before AAPC he was at Optum for 13 years and at Aetna Health Plans before that. He has been writing and publishing about healthcare since 1979. He received his Bachelor's in Journalism from Idaho State University and his Master's of Professional Communication degree from Westminster College of Salt Lake City.

3 Responses to “Five G Codes Effective Oct. 1”

  1. Cynthia Barker says:

    Are these codes billable on an ADA form? I have searched high and low and have not found an answer to this question.

  2. Michelle Songer says:

    These codes should only be billed by FQHC facilities on UB04 claim form. These codes would not apply to any other facility type.

  3. Tammy Mason says:

    I would like to know how to explain these excess charges to patients. They accuse us of fraud and double billing and no matter how we explain it they don’t understand.

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