What insurance policy changes affect HCPCS G0402?

There are 13 tracked policy changes affecting HCPCS G0402, including updates from Harvard Pilgrim Health Care, Health Net, Anthem BCBS. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS G0402?

Payers that have issued tracked updates for HCPCS G0402 include: Harvard Pilgrim Health Care, Health Net, Anthem BCBS, Blue Cross of Idaho, Maryland Medicaid, Medical Mutual of Ohio, BCBS Michigan, Florida Blue.

How do I get notified when HCPCS G0402 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS G0402. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for HCPCS G0402?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

G0402 — Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment: Insurance Policy Changes

G0402 Insurance Policy Changes

HCPCS G0402 is officially defined as "Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment." HCPCS G0402 is referenced in 13 tracked payer policy changes from Harvard Pilgrim Health Care, Health Net, and 6 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS G0402 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact

[Ohio] Reimbursement policy update: Screening Services with Related Evaluation and Management Services — Professional

Anthem BCBS·Effective Apr 1, 2026

Effective April 1, 2026, Anthem will update its reimbursement policy to clarify that screening services, annual gynecological exams, counseling, medical nutrition therapy, prolonged services, and visual acuity screenings cannot be billed separately when provided on the same day as preventive medicine visits (CPT 99381-99387, 99391-99397, G0402). Modifier 25 appending will not override this bundling restriction. The policy will be renamed to reflect preventive medicine services focus.

G0402 Insurance Policy Changes

Reimbursement updates for preventive medicine services

26-084 Commercial Plans Will No Longer Accept Medicare-Specific G-Codes Starting April 1, 2026

[Ohio] Reimbursement policy update: Screening Services with Related Evaluation and Management Services — Professional

[New York] Reimbursement policy update: Screening Services with Related Evaluation and Management Services — Professional

[Georgia] Reimbursement policy update: Screening Services with Related Evaluation and Management Services — Professional

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PT 49-26: GE Modifier Clarification

MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Updated language CCM, VCS, CoCM, and telehealth

MAPAP113 - Billing Requirements for Rural Health Centers (RHCs) - Revised exclusions added

Guidelines for Coding a Wellness Visit and Sick Visit Occurring on the Same Day

Do you have time for a Quality Minute about annual wellness visits?

The Annual Wellness Visit: Preventive Care for Your Medicare Advantage Patients

Coding Newsletter - Annual Wellness Visit