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    OpenPayerBilling CodesProcedures / Professional ServicesHCPCS hcpcs-g0405-ecg-interpretation-report-initial-preventive-exam
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    HCPCS G0405: 12-Lead ECG Interpretation and Report for Initial Preventive Physical

    Medicare pays $9 and commercial payers pay $12 on average nationally for this procedure.

    HCPCS Level II code G0405 describes a 12-lead electrocardiogram performed as a screening during the Initial Preventive Physical Examination, where only the interpretation and report are provided; service type: diagnostic electrocardiographic interpretation and reporting; typical site of service: outpatient preventive visit or clinic setting during an initial physical exam.

    For related coverage guidance, see recent payer policy updates: Esophagogastroduodenoscopy (EGD) Coverage Policy, Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD), Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease.

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    National Reimbursement Benchmarks

    Across national payers, Medicare’s mean rate of $8.6 compares closely with BUCA’s average commercial mean of $11.7, leaving BUCA about $3.1 higher on average. This places Medicare near the middle of the national distribution while BUCA sits above Medicare but below the highest commercial means (e.g., UnitedHealth Group and Blue Cross Blue Shield).

    Dispersion measured by the interquartile range (P75 minus P25) varies notably: Blue Cross Blue Shield and UnitedHealth Group show the widest IQRs at $5.5 and $8.0 respectively, indicating broader variability in allowed rates. Aetna and Cigna exhibit much tighter spreads at $2.4 and $1.5 respectively, reflecting more consistency around their central tendencies. BUCA’s IQR is $4.6 and Medicare’s IQR is $1.0.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old patient presents for an Initial Preventive Physical Examination (IPPE) with complaints of intermittent palpitations and a history of hypertension. The primary care physician (Internal Medicine or Geriatric Medicine) orders an electrocardiogram screening to evaluate rhythm and conduction as part of the IPPE. The ECG recording is performed by clinic staff or a cardiology technician in the outpatient clinic, and the tracing is sent for physician interpretation. The billed service is for the interpretation and report only (G0405) when the ECG tracing was obtained elsewhere or earlier in the visit and only the professional interpretation is rendered during the IPPE.

    Typical workflow:

    • Patient check-in and vital signs obtained.

    • Technician performs or confirms availability of a prior 12-lead ECG tracing.

    • Physician or cardiology specialist reviews the tracing, documents interpretation and generates a formal report.

    • Coding/billing staff assigns G0405 for interpretation and report only when the IPPE screening ECG interpretation is billed separately from the technical component.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207RC0000XCardiovascular Disease PhysicianAn internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threaten…
    207R00000XInternal Medicine PhysicianA physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
    207RG0300XGeriatric Medicine (Internal Medicine) PhysicianAn internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects o…
    2080P0204XPediatric Emergency Medicine (Pediatrics) PhysicianA pediatrician who has special qualifications to manage emergencies in infants and children.
    363LN0000XNeonatal Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
    310400000XAssisted Living FacilityA facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitorin…
    1835P0200XPediatric PharmacistA licensed pharmacist who has demonstrated specialized knowledge and skill in the delivery of patient care services by pharmacists that ensures the sa…
    133NN1002XNutrition Education NutritionistDietary & Nutritional Service Providers · Nutritionist

    Related ICD-10-CM Codes

    29 rows

    ICD-10-CM CodeDescription
    E11.9Type 2 diabetes mellitus without complications
    E66.9Obesity, unspecified
    E78.5Hyperlipidemia, unspecified
    F17.200Nicotine dependence, unspecified, uncomplicated
    G47.33Obstructive sleep apnea (adult) (pediatric)
    I10Essential (primary) hypertension
    I20.9Angina pectoris, unspecified
    I21.9Acute myocardial infarction, unspecified
    I25.10Atherosclerotic heart disease of native coronary artery without angina pectoris
    I44.1Atrioventricular block, second degree

    Showing 1–10 of 29

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    10 rows

    PolicyPayerEffective Date
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01
    Celiac Disease TestingOscar Health2026-10-01
    Laboratory Testing for the Diagnosis of Inflammatory Bowel DiseaseOscar Health2026-10-01
    Percutaneous Electrical Nerve Field Stimulation (PENFS)Cigna2026-09-15
    Colorectal Cancer ScreeningBlue Cross Blue Shield - New Mexico2026-09-04

    Related Codes

    HCPCS-G9490-HOME-ASSESSMENT-NON-HOMEBOUND

    HCPCS G9490: Home Visit Patient Assessment for Non-Homebound Beneficiary

    HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

    HCPCS G0008: Administration of Influenza Virus Vaccine

    HCPCS-G0009-PNEUMOCOCCAL-VACCINE-ADMINISTRATION

    HCPCS G0009: Administration of Pneumococcal Vaccine

    HCPCS-G0010-HEPATITIS-B-VACCINE-ADMINISTRATION

    HCPCS G0010: Administration of Hepatitis B Vaccine

    HCPCS-G0011-PREP-COUNSELING-HIV-RISK-REDUCTION-ADHERENCE

    HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment

    HCPCS-G0012-PRE-EXPOSURE-PROPHYLAXIS-INJECTION-HIV-PREVENTION

    HCPCS G0012: Injection of PrEP Drug for HIV Prevention

    HCPCS-G0013-PREP-INDIVIDUAL-COUNSELING-HIV-RISK-REDUCTION

    HCPCS G0013: Individual PrEP Counseling by Clinical Staff

    HCPCS-G0017-PSYCHOTHERAPY-CRISIS-FIRST-60-MINUTES-NON-OFFICE

    HCPCS G0017: Psychotherapy for Crisis, First 60 Minutes

    HCPCS-G0018-PSYCHOTHERAPY-CRISIS-ADDITIONAL-30-MINUTES-NON-OFFICE

    HCPCS G0018: Psychotherapy for Crisis, Additional 30 Minutes

    HCPCS-G0019-COMMUNITY-HEALTH-INTEGRATION-SDOH-CARE-COORDINATION

    HCPCS G0019: Community Health Integration, Person-Centered Assessment

    Showing 1–10 of 1996

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    93000Electrocardiogram, routine ECG with 12 leads; with interpretation and reportFull service including both tracing and interpretation when performed and billed together instead of G0405.
    93010Electrocardiogram, routine ECG with 12 leads; interpretation and report onlyCPT equivalent to professional-only interpretation; used in contexts where CPT coding is required instead of HCPCS G0405.
    93224External electrocardiographic monitoring up to 48 hours; scanning analysis with reportUsed when ambulatory continuous monitoring (Holter) is indicated after screening ECG for arrhythmia evaluation.
    93005Electrocardiogram, routine ECG with 12 leads; tracing only, without interpretation and reportRepresents the technical component when the clinic bills the tracing separately from the interpretation.