HCPCS code G0402 — Initial preventive exam.
Status: Active.
Effective Jan 1, 2009.
Source: CMS HCPCS Level II.
G0402
ActiveInitial preventive exam
Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
Category:
Procedures
Section:
G-codes: Procedures / Professional Services
Effective:
Jan 1, 2009
Code type:
alphanumeric
OPPS Status:
V
— Clinic or emergency department visit
OPPS APC:
5012
MUE — Medically Unlikely Edits
Maximum units of G0402 Medicare will pay for one beneficiary on one date of service. Claims exceeding the MUE are denied or returned for review.
| Service Type | Max Units / Day |
|---|---|
| Outpatient Hospital | 1 |
| Practitioner Services | 1 |
Source: CMS Medicare NCCI Medically Unlikely Edits
NCCI Edits
The following codes cannot be billed together with G0402 without appropriate documentation.
| Column 2 Code | Modifier |
|---|---|
| G0250 | Modifier may bypass edit |
| G0271 | Modifier cannot bypass edit |
| G0380 | Modifier may bypass edit |
| G0381 | Modifier may bypass edit |
| G0382 | Modifier may bypass edit |
| G0383 | Modifier may bypass edit |
| G0384 | Modifier may bypass edit |
| G0463 | Modifier may bypass edit |
Source: CMS National Correct Coding Initiative (NCCI)