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.
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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.