Question 1

What is HCPCS code G0402?

Accepted Answer

HCPCS code G0402 is "Initial preventive exam". Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment

Question 2

What category is G0402 in?

Accepted Answer

G0402 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G0402?

Accepted Answer

Use G0402 when billing for initial preventive exam. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is G0402 covered by Medicare?

Accepted Answer

Coverage for G0402 (Initial preventive exam) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for G0402?

Accepted Answer

Documentation for G0402 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).