CMS Pub. 100-04, ch. 18, § 80.5

When denying additional claims for G0344, G0366, G0367 and G0368, A/B MACs (A) and (B) shall use MSN 18.22

- This service was denied because Medicare only covers the one-time initial preventive physical exam with an

electrocardiogram within the first 6 months that you have Part B coverage, and only if that coverage begins on or after

January 1, 2005.

The Spanish version is: 18.22 - Este servicio fue denegado porque Medicare solamente cubre un examen fisico

preventivo con un electrocardiograma dentro de los primeros 6 meses que usted tenga cobertura de la Parte B, y sólo

si esta cobertura comienza en o después del 1 de enero de 2005.

When denying additional claims for G0402 (or claims with dates of service beyond the 12 month period) A/B MACs

(A) and (B) shall use MSN 20.91 - This service was denied. Medicare covers a one-time initial preventive physical

exam (Welcome to Medicare physical exam) if you get it within the first 12 months of the effective date of your

Medicare Part B coverage.

The Spanish version is: Este servicio fue negado. Medicare cubre un examen físico de “Bienvenido a Medicare”

ofrecido una sola vez si se obtiene dentro de los primeros 12 meses de la fecha efectiva de su inscripción a la Parte B

de Medicare.

When denying additional claims for screening EKG codes G0403, G0404 and G0405, A/B MACs (A) and (B) shall

use MSN 20.12 - This service was denied because Medicare only covers this service once a lifetime.

The Spanish version is: Este servicio fue negado porque Medicare sólo cubre este servicio una vez en la vida.