HCPCS code G0402: Welcome visit, first 12 months of Part B2026 Medicare rate & RVUs in Missouri
G0402 reports Medicare’s one-time Welcome to Medicare visit, including a prevention-focused health review and examination during the initial Part B enrollment period.
Medicare pays $163.20–$170.75 for G0402 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What G0402 covers
G0402 covers the one-time Welcome to Medicare visit, a prevention-focused review rather than a routine comprehensive physical. A physician or qualified nonphysician practitioner typically performs it in an office or outpatient setting. The clinician reviews medical and social history, assesses health risks, depression risk, functional ability and safety, performs an appropriate examination, and provides prevention counseling and a written screening schedule. Advance care planning may be discussed when the patient chooses to address it.
Report G0402 when the patient is within the first 12 months of Part B enrollment and the visit’s documented elements support the service. Record relevant history, risk and functional assessments, examination findings, counseling, and recommended preventive services. If a screening ECG is furnished, report the applicable ECG service separately using G0403 or its tracing and interpretation components, G0404 and G0405.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where G0402 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$163.20 to $170.75
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $169.54 | $112.78 |
| Metropolitan St. Louis, MO | $170.75 | $113.20 |
| Rest of Missouri | $163.20 | $111.09 |
How the G0402 rate is calculated
Each of G0402’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · G0402
RVUs × geographic indexes × conversion factor
Work2.60
2.60 RVUs× 1.000 GPCI
Practice expense2.46
2.46 RVUs× 1.000 GPCI
Malpractice0.17
0.17 RVUs× 1.000 GPCI
Adjusted RVUs
5.2300
Conversion factor
$33.4009
Medicare rate
$174.69
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for G0402
G0402 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · G0402
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$174.69
- Non-facility (office)
- $174.69
- Facility
- $114.23
Higher because the practice carries its own overhead.
G0402 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- G0438Annual wellness visitInitial visit, first AWV
- G0402 is the one-time Welcome to Medicare visit during the first 12 months of Part B enrollment. G0438 is the initial Annual Wellness Visit, a separate benefit.
- G0439Annual wellness visitSubsequent visit
- G0439 reports a subsequent Annual Wellness Visit. It is not used for the initial Welcome to Medicare service reported with G0402.
- G0403Preventive ECGInitial preventive examination
- G0402 reports the preventive visit. G0403 reports the associated screening ECG service, including its tracing, interpretation, and report.
G0402 billing questions
How is G0402 different from the initial Annual Wellness Visit?
G0402 is the one-time Welcome to Medicare visit available during the first 12 months of Part B enrollment. G0438 reports the initial Annual Wellness Visit, a separate preventive benefit.
Can G0402 be reported again as an annual visit?
No. G0402 is a one-time benefit, not a recurring annual visit code. Use the applicable Annual Wellness Visit code for a qualifying later wellness visit.
How should an ECG furnished at the visit be reported?
Report the ECG using G0403 when the service includes the tracing, interpretation, and report. G0404 and G0405 identify the tracing and interpretation/report portions, respectively.
What documentation supports G0402?
Document the patient’s Part B enrollment timing and the visit elements performed, including history, health-risk and functional assessments, examination, counseling, and preventive-service recommendations.
Is G0402 selected by visit time?
No time threshold is used to distinguish G0402. Selection is based on the patient’s eligibility for the one-time benefit and the documented preventive-visit elements.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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