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See a sample rate comparisonHCPCS G0402 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
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 |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for G0402 |
National average reimbursement for HCPCS G0402 by major payers:
$188.55
$184.46
$188.42
$178.47
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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
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See a sample payer proposalHCPCS G0402 vs. Other Initial Services for Medicare Enrollment Codes
The HCPCS G0402 code is part of the Procedures / Professional Services services used for Initial Services for Medicare Enrollment. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS G0402 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| G0400-HCPCS | Low | Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels |
| G0402-HCPCS | Low | Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment |
| G0403-HCPCS | Low | 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.
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