G0475 Hiv combination assay

What G0475 is

Hiv antigen/antibody, combination assay, screening

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

Medicare payment for G0475 (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 G0475 at 1 unit per date of service for practitioner claims (MAI 2 - date of service edit (absolute): units above the MUE never pay), rationale: CMS Policy. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.

Billed with G0475? These codes are bundled into it

G0475 is a Column 1 code in 10 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.

G0475 is bundled into these codes

G0475 appears as a Column 2 code in 1 active edits. Reported with one of these Column 1 codes on the same date of service, G0475 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.