2025 HCPCS code G0404
(Active) Effective Date: N/A Revision Date: N/A Diagnostic - Electrocardiogram Preventive Services Feed
ECG tracing only (no interpretation or report), performed as a screening for the Initial Preventive Physical Examination (IPPE).
Modifiers may be applicable depending on the circumstances of service. Consult the most up-to-date Medicare guidelines for appropriate modifier usage.
Medical necessity is established when the 12-lead ECG is performed as part of a beneficiary's Initial Preventive Physical Examination (IPPE) within the first 12 months of their Medicare Part B coverage period. The service should be medically appropriate for the patient based on their age and risk factors.
The clinical responsibility lies with the physician or qualified healthcare professional performing and recording the 12-lead ECG tracing during the IPPE. They are responsible for proper electrode placement, recording of the tracing, and ensuring the accuracy of the procedure.
In simple words: This code covers a simple heart tracing test (ECG) done as part of a person's first Medicare checkup.The test records the heart's electrical activity but doesn't include an explanation of the results.
This HCPCS code, G0404, represents a screening routine electrocardiogram (ECG) tracing, without interpretation and report, performed as part of an Initial Preventive Physical Examination (IPPE).The provider attaches 12-lead electrodes to the patient, records the heart's electrical signals, creating a waveform graphic.No interpretation or report of the results is included.
Example 1: A 67-year-old male enrolls in Medicare.As part of his IPPE, a physician performs a 12-lead ECG tracing (G0404).The tracing is reviewed by the physician to rule out any immediate cardiac emergencies, but a formal interpretation is not done at this time., A 72-year-old female beneficiary receives her initial Medicare wellness visit which includes an IPPE.The healthcare provider performs an ECG (G0404) only for screening purposes within the initial visit. A formal interpretation is later done and billed separately as G0405 if needed., During an IPPE, a physician's assistant (PA) performs a 12-lead ECG tracing (G0404) on a 75-year-old patient, and the physician reviews the tracing to ensure it does not warrant immediate attention. The patient does not require further ECG testing at this time.
Medical record should document the performance of the 12-lead ECG tracing as part of the IPPE.Specific details such as date of service, patient identification, and the fact that only a tracing (without interpretation or report) was performed, must be recorded.
** This code is specifically for use in the context of an Initial Preventive Physical Examination (IPPE) for Medicare beneficiaries.It is not to be used for other ECG tracings. The payment for this service may vary depending on the payer, location, and other applicable factors. Always verify with the specific payer for current coverage and payment details.
- Payment Status: Active
- Modifier TC rule: Technical Component (TC) modifier does not apply to this code.
- Specialties:Cardiology, Internal Medicine, Family Medicine
- Place of Service:Office, Clinic