G0472 Hep c screen high risk/other

What G0472 is

Hepatitis c antibody screening, for individual at high risk and other covered indication(s)

HCPCS Level II long description, CMS October 2026 file. See the G codes page for the full section.

Medicare payment for G0472 (CY2026)

This code has no Physician Fee Schedule rate: Statutory exclusion - not payable under the Physician Fee Schedule. It may be paid under a different fee schedule (clinical laboratory, DMEPOS, anesthesia) or not paid at all - check the relevant CMS schedule.

Medically Unlikely Edit (MUE)

Medicare caps G0472 at 1 unit per date of service for practitioner claims (MAI 2 - date of service edit (absolute): units above the MUE never pay), rationale: Code Descriptor / CPT Instruction. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.

G0472 is bundled into these codes

G0472 appears as a Column 2 code in 1 active edits. Reported with one of these Column 1 codes on the same date of service, G0472 is the code that denies.

Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.