HCPCS G0404: 12-Lead ECG Tracing Only for Initial Preventive Exam
HCPCS Level II code G0404 describes a routine 12-lead electrocardiogram performed as a screening during the Initial Preventive Physical Examination where only the ECG tracing is recorded without interpretation and report, typically provided as a screening diagnostic service in an outpatient clinic or primary care setting during the preventive visit.
For related coverage guidance, see recent payer policy updates: Esophagogastroduodenoscopy (EGD) Coverage Policy, Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD), Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing.
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National Reimbursement Benchmarks
Across payers, Medicare and BUCA define opposite poles of the national rate landscape for G0404: Medicare’s mean is $7.30 while BUCA’s average commercial mean is $11.00, indicating commercial averages sit notably above the Medicare baseline. Median values in several commercial payers run higher than Medicare’s central tendency, reinforcing that typical commercial reimbursement exceeds the Medicare mean.
Dispersion (P75 minus P25) highlights variability differences: Blue Cross Blue Shield’s spread is $7.0, UnitedHealth Group’s spread is $8.1, BUCA’s spread is $5.0, Aetna’s spread is $3.0, and Cigna’s spread is $1.1. Cigna shows the tightest distribution at $1.10, while UnitedHealth Group displays the widest at $8.10, with Blue Cross Blue Shield also showing substantial dispersion.