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Describe a service in plain words, or type a CPT/HCPCS code.

HCPCS G0469

Fqhc visit, mh new pt

Priced under the Clinical Laboratory Fee Schedule (CLFS), not the RVU formula.

HCPCS Level II

No national payment amount

Status X is not separately payable under the PFS.

Did Medicare pay separately for HCPCS G0469 in Q2 2022? Copy link

Not at a published national rate. HCPCS G0469 carries status X (statutory exclusion) in the Q2 2022 release. The statutory definition of physician services does not include this item. Treat the blank amount as unpriced, not as $0.

Source: Physician relative value file (Q2 2022) · effective April 2022 · materially updated Aug 4, 2026 · compact facts

Why isn't there a national PFS amount?

  • Status X (Statutory exclusion): The statutory definition of physician services does not include this item.
  • Status X is not separately payable under the PFS.

CMS evidence · 2 sources

Open evidence
Physician relative value file (Q2 2022) · rvu22b.zip (PPRRVU22_APR.csv row 1,731)

See full source & method below

Common questions Copy link

Why is there no payment amount for G0469?

Its status indicator is X (statutory exclusion). The statutory definition of physician services does not include this item. The blank is deliberate: the amount is either unknown or paid under another provision, so reading it as $0 would be wrong.

Why would a Medicare claim for G0469 be denied or paid less?

These come from CMS indicators on this page, not general billing advice.

  • Its status indicator is X (statutory exclusion) — The statutory definition of physician services does not include this item. See status indicators

Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.

When does this rate change?

CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

Payment rules

Applicable payment rules Copy link

Only the rules that can matter for G0469, each linking to its detail on this page.

Facility/non-facility Not determined
Professional/technical component Does not apply
Bilateral adjustment Does not apply
Multiple-procedure reduction Does not apply
Assistant/co-surgeon treatment Does not apply
Global surgery Does not apply
NCCI same-day edits Not determined MUE behavior Not determined Other fee-schedule routing Applies
Contractor pricing Does not apply

Global period: what G0469's fee already covers Copy link

XXX Does not apply

The global surgery concept does not apply to this code.

Modifiers that report work outside G0469's global period
Modifier Reports
-25 A significant, separately identifiable E/M on the same day as the procedure, beyond its usual pre- and post-operative care.

A modifier reports what happened; it does not by itself make a service payable. Documentation has to support it.

Can you bill it with another code? Copy link

Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit between it and G0469.

See every current NCCI pair for G0469 →

History

Rate history by release Copy link

National non-facility amount for G0469 across quarterly releases.

Release Status Non-facility Facility
Q3 2026 Jul 1, 2026 – present X — —
Q2 2026 Apr 1, 2026 – Jun 30, 2026 X — —
Q1 2026 Jan 1, 2026 – Mar 31, 2026 X — —

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Source & method

Show sources

This is computed from CMS's Medicare Physician Fee Schedule Q2 2022 release (schedule pfs, effective April 2022). National amounts apply a GPCI of 1.000 and leave sequestration off. The status indicator decides payability, never the RVU values, so a blank RVU stays blank. Releases are immutable: a rate retrieved for a past quarter always reflects that release. CMS owns the code description shown for HCPCS Level II codes. Our methodology covers the depth: sourcing, parsing, versioning, and how we cross-check claims before they ship.

Physician relative value file (Q2 2022) · rvu22b.zip (PPRRVU22_APR.csv row 1,731)

Use the (i) buttons next to each amount above for the exact row, columns, and math.

Cite this rate

This link keeps pointing at the Q2 2022 figures, even after a newer release lands.

HCPCS G0469 Medicare Physician Fee Schedule rate (Q2 2022). Localis. https://localishealth.com/hcpcs/G0469/2022/B