2025 HCPCS code G0405
(Active) Effective Date: N/A Revision Date: N/A Diagnostic - Electrocardiogram (ECG) Interpretation and Report Preventive Services Feed
Interpretation and report only of a 12-lead EKG performed as a screening for the Initial Preventive Physical Examination (IPPE).
Modifiers may be applicable depending on the circumstances of the service.Consult the appropriate coding guidelines for specific modifier usage and refer to the NCCI edits for potential code pairing requirements.
The medical necessity for a 12-lead ECG during an IPPE is based on the American College of Cardiology/American Heart Association guidelines for preventive cardiology.A screening ECG is often considered medically necessary to detect asymptomatic cardiac conditions in individuals at increased risk for cardiovascular disease. For Medicare reimbursement, the service must be provided within the first 12 months of the patient's Part B enrollment.
The clinical responsibility lies with the physician or qualified healthcare professional who interprets the 12-lead ECG tracing obtained as part of the IPPE.This includes analyzing the waveforms, identifying any abnormalities, and documenting the findings in a clear and concise report. The clinician must possess the necessary expertise to accurately interpret the ECG data.
In simple words: This code covers the doctor's review and explanation of a heart tracing (ECG) done as part of a new Medicare patient's first checkup.The doctor only looks at the results and doesn't do the tracing itself. This is separate from codes that include actually getting the tracing.
This HCPCS code represents the interpretation and report of a routine 12-lead electrocardiogram (ECG) performed as part of an Initial Preventive Physical Examination (IPPE).The code encompasses only the physician's review and analysis of the ECG tracing, not the acquisition of the tracing itself.This service is distinct from codes G0403 (ECG with interpretation and report) and G0404 (ECG tracing only), which include additional components. The interpretation and report should clearly document any findings and their clinical significance.
Example 1: A 68-year-old male newly enrolled in Medicare undergoes an IPPE.As part of the exam, a 12-lead ECG is performed.The physician reviews the tracing and generates a report noting a normal sinus rhythm.Code G0405 is used to bill for the interpretation and report of this ECG., A 72-year-old female with a history of hypertension presents for an IPPE.A 12-lead ECG is obtained. The physician's interpretation reveals left ventricular hypertrophy. This finding is documented in the patient's chart and billed using code G0405. The physician may further order additional tests to assess the extent and management of the hypertrophy., An 80-year-old patient with a history of atrial fibrillation is having an IPPE. The 12-lead ECG performed during the IPPE is interpreted and a report is generated using code G0405. The report confirms the diagnosis of atrial fibrillation and notes no significant changes since the last ECG.
* Patient's medical record documenting the IPPE encounter.* The 12-lead ECG tracing.* Physician's interpretation and report of the ECG, including the date and time of interpretation and specific findings.
** This code should only be reported when the physician or qualified healthcare professional interprets and reports a 12-lead EKG as a component of an initial preventive physical examination (IPPE) for a new Medicare beneficiary. The acquisition of the ECG is reported separately with code G0404 if done by the physician or with other relevant code if done by other qualified personnel.
- Revenue Code: 0450 (Electrocardiology)
- RVU: The RVUs for this code vary depending on the geographic location and other factors. Consult the CMS fee schedule for the most current values.
- Global Days: Not applicable; this is a diagnostic service.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Historical fee schedule data can be accessed through the CMS website or other relevant payer resources. Note that these values can vary significantly over time.
- Specialties:Cardiology, Internal Medicine, Family Medicine
- Place of Service:Office, Clinic