Summary & Overview
HCPCS G0467: FQHC Visit for Established Patient, Face-to-Face
HCPCS Level II code G0467 denotes a Federally Qualified Health Center (FQHC) visit for an established patient — a medically necessary, face-to-face encounter during which one or more FQHC services are delivered and a typical bundle of Medicare-covered services is provided per diem. This code matters nationally because FQHCs serve high-need, underserved populations and G0467 is central to describing routine established-patient outpatient encounters at these federally funded centers.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise benchmarks and context around how G0467 is used in billing workflows, the clinical setting and service type it represents, and common billing considerations tied to FQHC operations. The publication summarizes payer coverage patterns, common modifier usage where available, and implications for encounter-level reporting and per-diem bundled services at FQHCs.
This national overview explains the clinical context for G0467, clarifies the typical site of service, and outlines what to expect in payer engagement and coding practice for established-patient FQHC visits. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code G0467 describes a Federally Qualified Health Center (FQHC) visit for an established patient. This code represents a medically necessary, face-to-face, one-on-one encounter between an established patient and an FQHC practitioner during which one or more FQHC services are rendered. The code includes a typical bundle of Medicare-covered services that would be furnished per diem to a patient receiving an FQHC visit.
Service type: Primary care / FQHC visit services
Typical site of service: Federally Qualified Health Center (FQHC) outpatient clinic
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an established adult or pediatric patient who presents to a Federally Qualified Health Center (FQHC) for a medically necessary, face-to-face visit with an FQHC practitioner. Example: a 54-year-old patient with hypertension and type 2 diabetes arrives for routine chronic disease management. At registration the patient’s demographic and insurance information is verified, vitals (blood pressure, weight, temperature) are recorded by clinical staff, medication reconciliation is performed, and brief point-of-care testing (e.g., fingerstick glucose, urine dipstick) may be completed. The clinician (physician, nurse practitioner, or physician assistant) conducts a focused history and exam, adjusts medications, reviews lab results, orders/refers for additional services (laboratory, imaging, behavioral health), documents the visit in the electronic health record, and provides patient education. Billing uses G0467 to represent the bundled, per-diem FQHC established patient visit when one-on-one, medically necessary services are furnished during that encounter. Typical workflow includes check-in, nursing intake, clinician encounter, orders and referrals, and check-out with follow-up scheduling and care coordination as needed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure or other service |