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HCPCS G0403 · Level II · G code

G0403: Electrocardiogram, routine ECG with 12 leads, HCPCS Level II G code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file.

Key facts for G0403

Medicare payment
$15.36
PFS non-facility, national
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
1
MAI 2
OPPS status
SI M
Service not billable to the FI/MAC
NCCI PTP pairs
14
11 hospital outpatient
LCDs and articles
0 / 0

TL;DR

G0403 is a Level II code from the G section (procedures and professional services, temporary), in use since 2009: "Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report". National PFS payment for G0403 is $15.36 in an office and no facility amount in a facility (October 2026), built from 0.17 work, 0.27 practice-expense and 0.02 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $15.44 at $33.5675. CMS caps G0403 at practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. In the NCCI PTP files v323r0 G0403 appears in 0 practitioner pairs as column 2 and 14 as column 1, and in 0 hospital outpatient pairs as column 2 and 11 as column 1. No current LCD or billing article lists G0403; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage). OPPS status indicator M: Service not billable to the FI/MAC. HCPCS record: BETOS T2C (other tests - EKG monitoring); pricing indicator 11; type of service 5 (diagnostic laboratory). 2 other active codes open with "Electrocardiogram"; related codes: G0404, G0405, G0402, G0400.

G0403 descriptor and code status

The October 2026 HCPCS Level II file describes G0403 as “Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0403 CPT code", G0403 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of G0403
FieldValue
Short descriptorEkg for initial prevent exam
Added to HCPCS2009-01-01
Last actionN (no maintenance), effective 2009-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator11: physician fee schedule, priced with national RVUs
BETOS categoryT2C: other tests - EKG monitoring
Type of service5: diagnostic laboratory

Medicare payment for G0403

National PFS payment for G0403 is $15.36 in an office and no facility amount in a facility (October 2026), built from 0.17 work, 0.27 practice-expense and 0.02 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $15.44 at $33.5675. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status A: active: paid separately under the physician fee schedule when covered. Global period XXX (global surgery concept does not apply); PC/TC indicator 4 (global test only).

PFS relative values and national payment for G0403
ComponentNon-facilityFacility
Work RVU0.170.17
Practice expense RVU0.27NA
Malpractice RVU0.020.02
Total RVUs0.46NA
National payment (CF $33.4009)$15.36n/a
Qualifying APM participant (CF $33.5675)$15.44n/a
  • Multiple procedures (modifier 51): no multiple-procedure reduction
  • Bilateral (modifier 50): 150% bilateral adjustment does not apply
  • Assistant at surgery: assistant at surgery paid only with documentation; co-surgeons: co-surgeons not permitted; team surgery: team surgeons not permitted
  • Physician supervision of diagnostic procedures: supervision concept does not apply

Hospital outpatient (OPPS Addendum B)

Status indicator M (Service not billable to the FI/MAC), with no separate OPPS payment rate.

Medically Unlikely Edits for G0403

CMS caps G0403 at practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. The practitioner MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.

MUE values for G0403 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction
Facility outpatient hospital12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction

The MUE lookup for G0403 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, G0403 is the column-2 (bundled) code in 0 active pairs and the column-1 code in 14 (43% modifier-allowed); 0 earlier pairs have been deleted.

Column-2 codes bundled into G0403 (practitioner)
Column-2 codePairs
0903T (CPT; descriptor licensed by AMA)1
0904T (CPT; descriptor licensed by AMA)1
0905T (CPT; descriptor licensed by AMA)1
36591 (CPT; descriptor licensed by AMA)1
36592 (CPT; descriptor licensed by AMA)1
93000 (CPT; descriptor licensed by AMA)1
93005 (CPT; descriptor licensed by AMA)1
93010 (CPT; descriptor licensed by AMA)1

In the hospital outpatient PTP file v323r0, G0403 is the column-2 (bundled) code in 0 active pairs and the column-1 code in 11 (55% modifier-allowed); 0 earlier pairs have been deleted.

Column-2 codes bundled into G0403 (hospital outpatient)
Column-2 codePairs
0903T (CPT; descriptor licensed by AMA)1
0904T (CPT; descriptor licensed by AMA)1
0905T (CPT; descriptor licensed by AMA)1
93000 (CPT; descriptor licensed by AMA)1
93005 (CPT; descriptor licensed by AMA)1
93010 (CPT; descriptor licensed by AMA)1
93040 (CPT; descriptor licensed by AMA)1
93041 (CPT; descriptor licensed by AMA)1

G0403 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check G0403 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0403

No current LCD or billing and coding article lists G0403. The HCPCS coverage code C means carrier judgment, so the Medicare contractor decides coverage, and any National Coverage Determination for the service still applies.

Denials to expect on G0403

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units of G0403 exceed the practitioner MUE of 1 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for G0403 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0403 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS G0403

What does HCPCS code G0403 describe?

"Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report" (short descriptor "Ekg for initial prevent exam"), in the G section (procedures and professional services, temporary). Added 2009-01-01.

Is G0403 a CPT code?

It is not. G0403 belongs to the G section (procedures and professional services, temporary) of HCPCS Level II, the CMS code set, not to AMA CPT. "G0403 CPT code" searches refer to it.

What does Medicare pay for G0403?

National PFS payment for G0403 is $15.36 in an office and no facility amount in a facility (October 2026), built from 0.17 work, 0.27 practice-expense and 0.02 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $15.44 at $33.5675.

How many units of G0403 can be billed per day?

CMS caps G0403 at practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. For the practitioner MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover G0403?

No current LCD or billing article lists G0403; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.