Federally Qualified Health Center (fqhc) Visit, Established Patient; 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 T in Kentucky

Kentucky Pricing in Context

In Kentucky, CPT code G0467 (Federally Qualified Health Center (fqhc) Visit, Established Patient; 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 T) carries an average Medicare payment of $61.73 — 21% above the national benchmark of $51.08. 22 providers across the state submitted claims for this procedure in 2023, performing 136 total services. Individual payments in KY ranged from N/A at the low end to N/A at the high end, reflecting differences in provider setting (office vs. facility), modifiers, and the specific geographic locality code applied within the state.

The average billed charge in Kentucky is $239.27, which is the figure uninsured patients would most likely encounter before any negotiation or charity discount. Medicare, by statute, only reimburses the allowed amount — the balance between billed and paid is written off under provider participation agreements. Insured patients generally pay a negotiated rate that falls between these two figures; the exact amount depends on plan design, deductible status, and in-network participation. Because Kentucky sits above the national Medicare average, commercial rates in the state may also run higher than the US median.

Using RAND 2024 commercial-to-Medicare ratios for Temporary Procedures procedures, the estimated commercial insurance price in Kentucky lands near $185.71, with self-pay cash prices typically around $132.12. Before scheduling, patients can request a Good Faith Estimate under the No Surprises Act, compare cash rates from hospital Machine-Readable Files, and confirm whether the provider is in-network with their specific plan. This page presents CMS reference data for informational use; it does not constitute medical or financial advice.