| HCPCS Code: |
G0404 |
| Long Description: |
Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination |
| Short Description: |
Ekg tracing for initial prev |
| Pricing Indicator 1: |
11 (Price established using national rvu's) |
| Multiple Pricing Code: |
A (Not applicable as HCPCS priced under one methodology) |
| Statute Number: |
|
| Coverage Code: |
C (Carrier judgment) |
| ASC Payment Group Code: |
|
| Processing Note Number: |
0153 |
| Berenson-Eggers Type of Service (BETOS) Code: |
T2C (Other tests - EKG monitoring) |
| Type of Service Code 1: |
5 (Diagnostic laboratory) |
| Anesthesia Base Unit Quality: |
0 |
| Code Added: |
01-01-2009 |
| Action Effective Date: |
01-01-2009 |
| Action Code: |
N (No maintenance for this code) |
