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.

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HCPCS G0469: Federally Qualified Health Center Mental Health New Patient Visit

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Get alerted when payer policies referencing G0469 are released or updated.

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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 Code	Description	Relationship to This Procedure
`90791`	Psychiatric 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.
`90832`	Psychotherapy, 30 minutes with patient	Used for timed psychotherapy sessions that may occur during or after the initial FQHC mental health visit if billed separately per payer policy.
`90834`	Psychotherapy, 45 minutes with patient	Used for longer psychotherapy sessions adjacent to the initial visit, when psychotherapy is provided as a separately billable service.
`90837`	Psychotherapy, 60 minutes with patient	Used for extended psychotherapy sessions that may follow the initial evaluation if documented and billed separately.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	May be billed in related outpatient primary care workflows when follow-up medical management or coordination occurs, distinct from `G0469` if payer permits separate billing.
`99406`	Smoking and tobacco use cessation counseling, intermediate, greater than 3 minutes up to 10 minutes	Example of adjunctive counseling services that might be provided same day and billed separately per payer rules.

Related Modifiers

9 rows

Modifier	Description	When to Use
23	Modifier -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…
22	Modifier –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…
51	Modifier –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…
52	Modifier ‑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…
53	Modifier 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…
54	Modifier ‑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…
55	Modifier –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…
56	Modifier ‑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…
62	Modifier 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	Specialty	Notes
2084P0800X	Psychiatry Physician	A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
103T00000X	Psychologist	A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, a…
101Y00000X	Counselor	A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and …
106H00000X	Marriage & Family Therapist	A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related menta…
363L00000X	Nurse Practitioner	(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
163WN0800X	Neuroscience Registered Nurse	Nursing Service Providers · Registered Nurse
172M00000X	Mechanotherapist	A practitioner of mechanotherapy examines patients by verbal inquiry, examination of the musculoskeletal system by hand, and visual inspection and obs…
207YP0228X	Pediatric Otolaryngology Physician	A pediatric otolaryngologist has special expertise in the management of infants and children with disorders that include congenital and acquired condi…

Related ICD-10-CM Codes

28 rows

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

Showing 1–10 of 28

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

Frequently Asked Questions

References

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.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.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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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90791`	Psychiatric 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.
`90832`	Psychotherapy, 30 minutes with patient	Used for timed psychotherapy sessions that may occur during or after the initial FQHC mental health visit if billed separately per payer policy.
`90834`	Psychotherapy, 45 minutes with patient	Used for longer psychotherapy sessions adjacent to the initial visit, when psychotherapy is provided as a separately billable service.
`90837`	Psychotherapy, 60 minutes with patient	Used for extended psychotherapy sessions that may follow the initial evaluation if documented and billed separately.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	May be billed in related outpatient primary care workflows when follow-up medical management or coordination occurs, distinct from `G0469` if payer permits separate billing.
`99406`	Smoking and tobacco use cessation counseling, intermediate, greater than 3 minutes up to 10 minutes	Example of adjunctive counseling services that might be provided same day and billed separately per payer rules.

Related Modifiers

9 rows

Modifier	Description	When to Use
23	Modifier -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…
22	Modifier –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…
51	Modifier –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…
52	Modifier ‑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…
53	Modifier 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…
54	Modifier ‑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…
55	Modifier –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…
56	Modifier ‑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…
62	Modifier 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	Specialty	Notes
2084P0800X	Psychiatry Physician	A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
103T00000X	Psychologist	A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, a…
101Y00000X	Counselor	A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and …
106H00000X	Marriage & Family Therapist	A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related menta…
363L00000X	Nurse Practitioner	(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
163WN0800X	Neuroscience Registered Nurse	Nursing Service Providers · Registered Nurse
172M00000X	Mechanotherapist	A practitioner of mechanotherapy examines patients by verbal inquiry, examination of the musculoskeletal system by hand, and visual inspection and obs…
207YP0228X	Pediatric Otolaryngology Physician	A pediatric otolaryngologist has special expertise in the management of infants and children with disorders that include congenital and acquired condi…

Related ICD-10-CM Codes

28 rows

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

Showing 1–10 of 28

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

Frequently Asked Questions

References

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.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.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.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

HCPCS G0469: Federally Qualified Health Center Mental Health New Patient Visit

Sign up for hcpcs G0469 policy alerts

OpenPayer

HCPCS G0469: Federally Qualified Health Center Mental Health New Patient Visit

Sign up for hcpcs G0469 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

References

HCPCS G0469: Federally Qualified Health Center Mental Health New Patient Visit

Sign up for hcpcs G0469 policy alerts

HCPCS G0469: Federally Qualified Health Center Mental Health New Patient Visit

Sign up for hcpcs G0469 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What is HCPCS code G0469 used for?

What services and clinical activities are typically included in a G0469 FQHC mental health new patient visit?

Can I bill CPT codes like 90791 or psychotherapy codes in addition to G0469?

Which payers cover G0469 and how does payer policy affect billing?

What diagnoses are commonly associated with a G0469 visit?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What is HCPCS code G0469 used for?

What services and clinical activities are typically included in a G0469 FQHC mental health new patient visit?

Can I bill CPT codes like 90791 or psychotherapy codes in addition to G0469?

Which payers cover G0469 and how does payer policy affect billing?

What diagnoses are commonly associated with a G0469 visit?

References