Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonHCPCS G0402 Fee Schedule
Medicare rates as of October 2026
HCPCS G0402 is classified under Procedures / Professional Services, in the Initial Services for Medicare Enrollment subgroup.
Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment
| Key Fact | Detail |
|---|---|
| Service Type | Procedures / Professional Services Initial Services for Medicare Enrollment |
| Hospital Outpatient Group (APC) | APC 5012 - Clinic Visits and Related Services |
| Add-on Codes | G0506G0513 |
| Common Revenue Codes | 05210510Sign up to view all 6 |
| Medicare Fee Schedule | $174.69 national non-facility rate (2026)View Medicare rates for G0402 |
| Medicaid Fee Schedule | $152.52 median of the 5 states in the free previewView Medicaid rates for G0402 |
National average reimbursement for HCPCS G0402 by major payers:
$188.55
BCBS / Anthem
$184.46
UnitedHealthcare
$188.42
Aetna
$178.47
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for HCPCS G0402.
HCPCS G0402
5 of 25 sample ratesHigher to lower in this preview
Chad Osborne
Healing The Soul
$625.67Published rateChristina Beltre
Cleveland Clinic Mercy Hospital
$267.80Published rateZachary Redus
Family Practice Center, PC
$191.97Published ratePost Acute Specialists, LLC
$171.52Published rateMaria Stein Family Practice Inc, Schwieterman Family Physicians Inc
Maria Stein Family Practice, Inc.
$100.94Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Looking for other data?
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalHCPCS G0402 vs. Other Initial Services for Medicare Enrollment Codes
The table lists codes related to G0402. Select one to see its fee schedule.
| Code | Description |
|---|---|
| G0400-HCPCS | Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels |
| G0402-HCPCS | Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment |
| G0403-HCPCS | Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G0402. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G0402 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like HCPCS G0402) and we'll show you how you compare in 15 minutes or less.
Frequently Asked Questions
What APC is HCPCS G0402 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns HCPCS G0402 to APC 5012 (Clinic Visits and Related Services). An APC groups outpatient services that Medicare pays at the same base rate.
Which add-on codes are billed with HCPCS G0402?
CMS add-on code edits list HCPCS G0402 as a primary code for these add-on codes: G0506 and G0513.
Which revenue codes are billed with HCPCS G0402?
Hospital price transparency files list HCPCS G0402 under these revenue codes: including 0521, 0510, 0770, 0983 and 0960. A revenue code names the hospital department or charge category for the line; it does not change what the service is.