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HCPCS G0402Medical Service

Initial Preventive Physical Examination Face-to-face Visit

Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of standard insurance enrollment. Clinical pricing breakdown and utilization metrics across 12,361 practicing doctors nationwide.

$317.00
Peer Median Charge
Gross billed rate
$159.49
Standard Baseline
Customary allowable
2.0x
National Markup
Charge vs baseline
12,361
Active Physicians
Billing this code
Planning care or already received a bill for CPT G0402?Calculate total facility bundle costs or generate an assertive dispute settlement offer.

Understanding This Medical Fee

Gross Charge vs Negotiated Payment: The median physician charge for this service is $317.00. However, insured patients almost never pay this full amount directly. Insurers negotiate rates down toward the $159.49 baseline.

Self-Pay & Uninsured Guidance: If you are paying without insurance or out-of-network, request a prompt-pay cash discount. Most medical practices are willing to settle self-pay bills near the customary baseline rate rather than the full gross charge.

Key Questions for Your Doctor's Billing Office:
  • "Does Dr. [Name] participate in my specific insurance plan network?"
  • "What is the total self-pay or cash rate for code G0402 if paid upfront?"
  • "Are there separate facility, anesthesia, or pathology fees associated with this procedure?"