Preventive care
G0402 — Initial preventive physical exam , 'Welcome to Medicare' visit
The Welcome to Medicare Preventive Visit is a one-time Medicare benefit available within the first 12 months of enrolling in Medicare Part B.
- Typical setting: Doctor's office
- National avg charge (illustrative): $145-$185 Medicare allowed (approx. $160-$175 national Medicare average; $0 patient cost with assignment; covered only within first 12 months of Part B enrollment)
- Most-disputed reason: Billing outside the 12-month eligibility window: G0402 is only payable for dates of service within the first 12 months of Medicare Part B enrollment — claims outside this window will be denied
What it means
What G0402 actually means
The Welcome to Medicare Preventive Visit is a one-time Medicare benefit available within the first 12 months of enrolling in Medicare Part B. It reviews the beneficiary's medical and social history, performs screenings for vision, depression, and cognitive status, and creates a referral list for preventive services. It has no patient cost-sharing when the provider accepts assignment.
Common errors with this code
What goes wrong on real bills.
Most bills that look correct still contain at least one of these issues. Up to 49% of medical bills contain errors (CFPB).
- Billing outside the 12-month eligibility window: G0402 is only payable for dates of service within the first 12 months of Medicare Part B enrollment — claims outside this window will be denied
- Billing G0402 after G0438: once an initial AWV (G0438) has been billed, G0402 cannot be billed again — these are different benefits in a fixed sequence (G0402 first, then G0438, then G0439 annually)
- Confusing with a routine physical: patients may be incorrectly told this replaces an annual physical exam — the IPPE does not include a head-to-toe physical and is focused on prevention planning
If you see G0402 on your bill
Three steps before paying.
1. Get the itemized bill. If your statement only shows a summary, request the CPT-level itemized bill before paying. Generate the request language →
2. Cross-check against the EOB. Compare what your insurer's Explanation of Benefits says you owe versus what the hospital is asking. They disagree more often than people think. Read the bill-vs-EOB guide →
3. Run a free Bill Scan. Upload the bill (and EOB if you have it) and BillBusted will flag the most likely issues with this specific code in your specific state. Run free scan →
Related codes
Other codes in this category.
People who land on G0402 often also see these adjacent codes on the same bill.
HCPCS
G0011 — Individual counseling for pre-exposure prophylaxis (prep) by physician or qualified health care professional (qhp) to prevent human immunodeficiency virus (hiv), includes hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence, 15-30 minutes
Hiv prep counsel, md 15-30m
HCPCS
G0012 — Injection of pre-exposure prophylaxis (prep) drug for hiv prevention, under skin or into muscle
Injection of hiv prep drug
Related BillBusted guides
Plain-English reads if you see G0402 on a bill.
G0402 FAQ
Plain-English answers.
What does G0402 usually cost?
$145-$185 Medicare allowed (approx. $160-$175 national Medicare average; $0 patient cost with assignment; covered only within first 12 months of Part B enrollment). Costs vary by region, payer contract, and whether the service was performed in a hospital outpatient department (which adds a facility fee) versus a free-standing clinic.
What's the most common billing error on G0402?
Billing outside the 12-month eligibility window: G0402 is only payable for dates of service within the first 12 months of Medicare Part B enrollment — claims outside this window will be denied
What should I do if I see G0402 on my bill?
Request the itemized bill and the matching EOB from your insurer. Compare the units/quantity billed against what you actually received. Run a free BillBusted scan to flag the most likely errors specific to G0402 before paying.
Don't pay G0402 blindly.
The free scan tells you in under 60 seconds whether this charge looks reasonable for your situation.