`G0403` Ekg for initial prevent exam

Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report

Medicare coverage: Carrier judgment
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 1 units per day (policy), rationale: Code Descriptor / CPT Instruction
Outpatient hospital: max 1 units per day (policy), rationale: Code Descriptor / CPT Instruction

Medicare pricing for G0403

Physician Fee Schedule (CY 2026, RVU26D)

Status A: active, paid separately under the PFS if covered. National amounts: non-facility $15.36, facility $15.36 (total RVUs 0.46 / 0.46 × $33.4009 conversion factor; facility NA: rarely or never done in that setting). Work RVU 0.17, practice expense RVU 0.27 non-facility and 0.27 facility, malpractice RVU 0.02. Global period XXX. Qualifying APM participants are paid at a $33.5675 conversion factor.

Payer policies and prior authorization for G0403

Payer coverage policies that name G0403

G0403 appears in 1 coverage policy from Anthem.

Payer	Policy	Role in policy	Reviewed	Document
Anthem	Resting Electrocardiogram Screening in Adults (CG-MED-62)	not covered	Aug 13, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

CO: $11.87 (chp_plus, non-facility), effective Jul 1, 2026
ND: $16.90 (physician), effective Aug 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

G0403 Ekg for initial prevent exam