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    v1.0.31
    OpenPayerBilling CodesProcedures / Professional ServicesHCPCS hcpcs-g0469-fqhc-mental-health-new-patient-visit
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    HCPCS G0469: Federally Qualified Health Center Mental Health New Patient Visit

    HCPCS Level II code G0469 describes a federally qualified health center (FQHC) mental health new patient visit, a medically necessary, face-to-face, one-on-one encounter between a new patient and an FQHC practitioner during which one or more FQHC services are rendered and a typical bundle of Medicare-covered services for a mental health visit is provided; service type: outpatient mental health evaluation and treatment visit; typical site of service: federally qualified health center (FQHC) clinic or outpatient facility.

    For related coverage guidance, see recent payer policy updates: Achalasia and Gastroesophageal Reflux Disease (GERD) - Minimally Invasive Procedures - Medical Policy, Esophageal Brush Biopsy, Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disorders.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 28-year-old patient presents to a Federally Qualified Health Center (FQHC) as a new patient reporting increasing depressive symptoms, difficulty sleeping, and impaired occupational functioning over the past two months. The initial encounter is a medically-necessary, face-to-face, one-on-one mental health visit with an FQHC practitioner (for example, a licensed clinical social worker, psychiatric nurse practitioner, or psychiatrist) who performs a comprehensive assessment, documents history of present illness, reviews medications and past psychiatric treatment, conducts a mental status examination, and initiates a treatment plan which may include psychotherapy, medication management referral, and coordination with primary care.

    The clinical workflow includes front-desk registration and verification of insurance (including Medicare or commercial payors such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and others), triage by nursing staff, a timed one-on-one evaluation and management session with the mental health clinician, documentation of services and clinical findings in the electronic health record, and billing the encounter with the FQHC-specific HCPCS Level II code G0469. The visit bundles typical Medicare-covered services provided per diem during a mental health visit at an FQHC, and may involve care coordination, brief ancillary services, and scheduling follow-up. If additional services (e.g., procedures, extended time, or services requiring separate billing) are performed, appropriate modifiers and separate CPT/HCPCS codes are appended as indicated by payer policy.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    90791Psychiatric diagnostic evaluation (no medical services)Commonly used for comprehensive initial psychiatric assessment when billed separately by a qualified mental health clinician; may be reported alongside G0469 only if payer allows separate billing for an unbundled psychiatric diagnostic evaluation.
    90832Psychotherapy, 30 minutes with patientUsed for timed psychotherapy sessions that may occur during or after the initial FQHC mental health visit if billed separately per payer policy.
    90834Psychotherapy, 45 minutes with patientUsed for longer psychotherapy sessions adjacent to the initial visit, when psychotherapy is provided as a separately billable service.
    90837Psychotherapy, 60 minutes with patientUsed for extended psychotherapy sessions that may follow the initial evaluation if documented and billed separately.
    99213Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutesMay be billed in related outpatient primary care workflows when follow-up medical management or coordination occurs, distinct from G0469 if payer permits separate billing.
    99406Smoking and tobacco use cessation counseling, intermediate, greater than 3 minutes up to 10 minutesExample of adjunctive counseling services that might be provided same day and billed separately per payer rules.

    Related Modifiers

    9 rows

    ModifierDescriptionWhen to Use
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    54Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    56Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    2084P0800X
    103T00000X
    101Y00000X
    106H00000X
    363L00000X
    163WN0800X
    172M00000X
    207YP0228X

    Related ICD-10-CM Codes

    28 rows

    ICD-10-CM CodeDescription
    F06.30Mood disorder due to known physiological condition, unspecified
    F32.0Major depressive disorder, single episode, mild
    F32.1Major depressive disorder, single episode, moderate
    F32.9Major depressive disorder, single episode, unspecified
    F33.1Major depressive disorder, recurrent, moderate
    F33.2Major depressive disorder, recurrent severe without psychotic features
    F34.1Dysthymic disorder
    F41.1Generalized anxiety disorder
    F41.9Anxiety disorder, unspecified
    F43.10Post-traumatic stress disorder, unspecified

    Showing 1–10 of 28

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    10 rows

    PolicyPayerEffective Date
    Achalasia and Gastroesophageal Reflux Disease (GERD) - Minimally Invasive Procedures - Medical PolicyHealth-New-England2027-02-01
    Esophageal Brush Biopsycaresourcegeorgia2026-12-01
    Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disordersbcbsvermont2026-12-01
    Gastric Pacing/Gastric Electrical Stimulation (GES)Cigna2026-11-15
    Percutaneous Electrical Nerve Field Stimulation for Disorders of Gut-Brain Interactionpremerabluecrossofwashington2026-11-06
    Percutaneous electrical nerve field stimulation for disorders of gut-brain interactionpremerabluecrossofwashington2026-11-06
    Percutaneous Electrical Nerve Field Stimulation for Disorders of Gut-Brain Interactionpremerabluecrossofwashington2026-11-06
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Non-invasive Testing for Liver FibrosisModa Health2026-11-01
    Surgical Site of Care - Colonoscopy and Sigmoidoscopyregence2026-11-01

    Related Codes

    HCPCS-G9490-HOME-ASSESSMENT-NON-HOMEBOUND

    HCPCS G9490: Home Visit Patient Assessment for Non-Homebound Beneficiary

    HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

    HCPCS G0008: Administration of Influenza Virus Vaccine

    HCPCS-G0009-PNEUMOCOCCAL-VACCINE-ADMINISTRATION

    HCPCS G0009: Administration of Pneumococcal Vaccine

    HCPCS-G0010-HEPATITIS-B-VACCINE-ADMINISTRATION

    HCPCS G0010: Administration of Hepatitis B Vaccine

    HCPCS-G0011-PREP-COUNSELING-HIV-RISK-REDUCTION-ADHERENCE

    HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment

    HCPCS-G0012-PRE-EXPOSURE-PROPHYLAXIS-INJECTION-HIV-PREVENTION

    HCPCS G0012: Injection of PrEP Drug for HIV Prevention

    HCPCS-G0013-PREP-INDIVIDUAL-COUNSELING-HIV-RISK-REDUCTION

    HCPCS G0013: Individual PrEP Counseling by Clinical Staff

    HCPCS-G0017-PSYCHOTHERAPY-CRISIS-FIRST-60-MINUTES-NON-OFFICE

    HCPCS G0017: Psychotherapy for Crisis, First 60 Minutes

    HCPCS-G0018-PSYCHOTHERAPY-CRISIS-ADDITIONAL-30-MINUTES-NON-OFFICE

    HCPCS G0018: Psychotherapy for Crisis, Additional 30 Minutes

    HCPCS-G0019-COMMUNITY-HEALTH-INTEGRATION-SDOH-CARE-COORDINATION

    HCPCS G0019: Community Health Integration, Person-Centered Assessment

    Showing 1–10 of 1996

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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