Medicare Reimbursement for G0403 – EKG for Initial Preventive Exam

HCPCS code G0403 describes an electrocardiogram (EKG) tracing performed as part of the Medicare Initial Preventive Physical Examination (the 'Welcome to Medicare' visit). This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted by locality, with non-facility and facility rates shown separately.

Medicare allowed amount (2026)

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 1 unit per patient per day — Date of Service Edit: Policy. Units above the MUE are denied; some MUEs can be exceeded only with appropriate documentation and modifiers where policy allows.

How the amount is calculated

Medicare pricing for this code is based on three Relative Value Units (RVUs) — work, practice expense (PE), and malpractice (MP) — which reflect physician effort, overhead costs, and liability insurance costs, respectively. Each RVU component is adjusted by a Geographic Practice Cost Index (GPCI) specific to the locality where the service is billed, to account for regional cost differences. The adjusted RVUs are summed and multiplied by the annual national Conversion Factor (CF) to produce a dollar amount. Because this code involves the same practice-expense inputs in both settings, the non-facility and facility PE RVUs are typically identical, meaning the allowed amount does not usually differ by place of service for this code.

RVUs — work 0.17, practice expense 0.27 (non-facility) / 0.27 (facility), malpractice 0.02 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

• This is an estimate only, not a guarantee of payment.
• Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the beneficiary or secondary payer is responsible for the remainder.
• Modifiers, claim-specific circumstances, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
• Locality-adjusted amounts depend on the GPCI values in effect for the billing locality and may change annually.
• Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

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Estimated Medicare Physician Fee Schedule amount. Medicare generally pays 80% after the deductible; actual amounts vary by locality, modifiers, sequestration, and annual updates. Verify with your MAC.