What the G0402 code description says
In short: G0402 is the code for the initial preventive physical examination, the "Welcome to Medicare" visit. It is covered once, in the first 12 months of Part B, at no charge if the provider accepts assignment.
Your mother's Medicare notice has a new line on it, and the code is G0402. It isn't a number you've seen before, and the word "physical" in the name makes it sound like something it isn't.
If the paperwork after a visit like this is piling up, a navigator can make the calls and track them. Navigate Care explains how that works and what it may cost on its what you will pay page.
The rest of this post is about the code itself: what it is called, what the visit includes, and what to ask if the bill doesn't match.
A CPT code that isn't one
People search for this as a CPT code. Strictly it isn't. CPT codes are five digits. G0402 is a letter and four digits, which makes it a Medicare Level II code, the kind CMS runs for services CPT leaves out. Our guide on reading Medicare CPT codes on a bill explains the two levels. For this page, the distinction only matters because you will see G0402 on a Medicare notice and not on a list of five-digit codes.
The official descriptor, as the American College of Physicians lists it, begins: "Initial preventive physical examination; face-to-face visit, services limited to new beneficiary". The rest of the wording limits it to the first 12 months of Medicare enrolment. We couldn't open the CMS page that prints the full line, and one coding site words the ending slightly differently, so check your own notice if the exact text matters.
In plain words: a new-to-Medicare check-in, done face to face, once.
What the visit includes
Medicare.gov calls it the Welcome to Medicare preventive visit. It covers:
- a review of your parent's medical and social history
- information on preventive services, including screenings and vaccines
- a review of risk factors for substance use disorder
- a body mass index (BMI) calculation and a simple vision test
- a review of the risk of depression
- an offer to talk about advance directives
- a written plan, such as a checklist, of screenings and vaccines to consider
Then the line that surprises people. Medicare.gov says: "This visit isn't a comprehensive physical exam." Don't expect a head-to-toe exam. The ACP page also lists three related codes, G0403, G0404 and G0405, for a screening ECG tied to this visit. If one of those turns up next to G0402, that is why.
What it costs
Medicare.gov says: "You pay nothing for the visit if your provider accepts assignment." Accepting assignment means the provider agrees to take Medicare's approved amount as full payment. Ask the office that before booking.
The catch is everything added to the visit. Medicare.gov says extra tests or services during the same visit may bring coinsurance or the Part B deductible, and if Medicare doesn't cover them, you may have to pay the full amount. A parent who brings up a sore knee can leave with two services on the claim: the free preventive visit and an ordinary problem visit. The coding site Findacode says a problem visit like that is reported separately, with modifier -25. It is billed like any other Part B service, and our Medicare Part B guide covers how the deductible and the 20% work.
That is usually where a "free" visit becomes a bill. Nothing went wrong. Two visits happened in one appointment.
When the visit applies
It is a one-time benefit. Medicare.gov puts the timing as "once within the first 12 months you have Part B". Miss the window and the visit is gone. Our guide on how to apply for Medicare covers the sign-up windows.
The two preventive visits side by side
| G0402, Welcome to Medicare | Yearly wellness visit | |
|---|---|---|
| How often | Once | Once every 12 months |
| When | Within the first 12 months of Part B | Not within 12 months of Part B enrolment |
| Needs the other first? | No | No, you don't need a Welcome visit |
| Is it a physical? | No | No |
Source: Medicare.gov, Welcome to Medicare visit and Medicare.gov, yearly wellness visits
So a parent who skipped G0402 isn't in trouble. The yearly visit opens once the first 12 months have passed. Neither visit is the "routine physical" many people expect, and Medicare.gov says a routine physical exam may be billed to you in full.
When the G0402 line looks wrong
Start with the date. If your parent has been on Part B for more than 12 months, a G0402 line is worth a call to the provider's billing office. Ask them to check it against the chart. You're asking a question, not accusing anyone, and codes are wrong by accident more often than anything else.
Then ask whether other services were added, and what each one was billed as. If a claim is denied, our guides on reading a Medicare denial letter and how to appeal a Medicare denial take you through it. We can't say an appeal will succeed. SHIP, the free State Health Insurance Assistance Program, will go through a notice with you and doesn't sell anything.
Where a navigator comes in
A navigator doesn't diagnose, treat or give medical advice, and doesn't replace your parent's doctor or SHIP. What a navigator does is follow through: calling the billing office, tracking the answer, booking the follow-up the preventive plan suggests. Medicare doesn't automatically cover navigation. Eligibility depends on a qualifying condition or need and a provider visit, and we confirm your cost before you start. It is usually $0 with supplemental coverage. Our compare page sets out how that differs from a private advocate.
Frequently asked questions
What is G0402 in medical billing?
It is the HCPCS code for the initial preventive physical examination, billed as a face-to-face visit for people new to Medicare. Medicare.gov calls the visit "Welcome to Medicare". It is a letter-and-four-digits code, not a five-digit CPT code.
Is G0402 covered by Medicare?
Yes, once, within the first 12 months of Part B. Medicare.gov says you pay nothing for the visit if your provider accepts assignment. Other services added during the visit may carry the Part B deductible and coinsurance.
Is the Welcome to Medicare visit a physical?
No. Medicare.gov says it isn't a comprehensive physical exam. It is a history review, a few measurements, a depression and substance use risk review, and a written plan of preventive services.
Can you have G0402 and a yearly wellness visit?
Yes, but not in the same 12 months. The yearly visit can't happen within 12 months of Part B enrolment, and you don't need the Welcome visit first, per Medicare.gov.
What do G0403, G0404 and G0405 mean?
They are screening ECG codes tied to the G0402 visit. G0403 covers the tracing plus the interpretation, G0404 the tracing only, and G0405 the interpretation only, according to the ACP.
