Preventive Services: Initial Preventive Physical Exam

HCPCS Codes

G0402 — 

Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment

G0403 — 

Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report

G0404 — 

Electrocardiogram, routine ECG with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination

G0405 — 

Electrocardiogram, routine ECG with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination

G0468 — 

Federally Qualified Health Center (FQHC) visit, IPPE or AWV; a FQHC visit that includes an initial preventive physical examination (IPPE) or annual wellness visit (AWV) and includes a typical bundle of Medicare-covered services that would be furnished per diem to a patient receiving an IPPE or AWV

ICD-10 Codes

Note: Additional ICD-10 codes may apply. Find individual change requests and specific ICD-10-CM codes on the CMS ICD-10 codes for National Coverage webpage. Find your MAC’s website for more information.

Medicare Covers

Patients with Medicare Part B once within the first 12 months of their Part B coverage

Frequency

• Once per lifetime
• Must occur no later than 12 months after the patient’s first Part B coverage period’s effective date

Patient Pays

HCPCS Codes

G0402:
No copayment, coinsurance, or deductible

G0403, G0404, and G0405:
Copayment or coinsurance, and deductible apply

G0468:
No copayment, coinsurance, or deductible

Note: You must provide an AWV or IPPE with a standard bundle of services available to all patients; get more information at Medicare Claims Processing Manual, Chapter 9, section 60.2.

Other Notes

Medicare Wellness Visits has more information.