Notice: This CMS-approved document has been submitted - Philips ...

CMS-1403-FC
● 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 at
least 12 leads; performed as a screening for the initial
preventive physical examination with interpretation and
report.
● G0404: Electrocardiogram, routine ECG with at
least 12 leads; tracing only, without interpretation and
report, performed as a screening for the initial preventive
physical examination.
● G0405: Electrocardiogram, routine ECG with at
least 12 leads; interpretation and report only, performed
as a screening for the initial preventive physical
examination.
The 4 existing G codes (G0344, G0366, G0367, and
G0367) will be active until December 31, 2008, for
beneficiaries who have the IPPE prior to January 1, 2009.
Work RVUs: We believe the additional work of
performing a measurement of an individual’s body mass index
and, upon consent of an individual, the discussion of
end-of-life planning, as described in the coverage section,
represent minimal work. A simple tool is used to determine
body fat based on an individual’s height and weight that
812