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HCPCS G0472 Medicare payment status

Priced under CLFS

G0472 · PFS Q4 2022 · Historical

Status X is not separately payable under the PFS.

View applicable payment rules
View CMS source and method

CMS RVU22DOctober 1 – December 31, 2022

PFS status evidence

Physician relative value file (Q4 2022) · rvu22d.zip (PPRRVU22_OCT.csv row 1,754)
Inspect PFS status evidence
Code
G0472
Release
Q4 2022, revision 1
Result
Priced under CLFS

Citations

  • Shows this code’s PFS status (X). Result: Priced under CLFS.

    Physician relative value file (PPRRVU)CMS RVU22DOctober 1 – December 31, 2022

    This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.

    PPRRVU22_OCT.csv row 1,754 in rvu22d.zip

    In the CMS file

    Loading rows 1,752–1,756 of PPRRVU22_OCT.csv…

    Download rvu22d.zip from CMS File fingerprint f8774a019545e1fd71536837b20b74674c014b1acef3435d93456857885190ab

Plain-text summaryReport a problem

HCPCS G0472 has no published national rate. It carries status X (statutory exclusion) in the Q4 2022 release. The statutory definition of physician services does not include this item. The blank amount means unpriced, not $0.

Why is there no national PFS amount for G0472?

Its status indicator is X (statutory exclusion). The statutory definition of physician services does not include this item. Status X is not separately payable under the PFS.

About this code

Hep c screen high risk/other

Payment considerations Copy link

Here are the inputs and payment rules that apply to this code. Each link takes you to the detail below.

Professional/technical component Applies Other fee-schedule routing Applies Rendering provider percentage Context required
Other payment indicators (8)
Facility/non-facility: Not determined, Bilateral adjustment: Does not apply, Multiple-procedure reduction: Does not apply, Assistant/co-surgeon treatment: Does not apply, Global surgery: Does not apply, NCCI same-day edits: Not determined, MUE behavior: Not determined, Contractor pricing: Does not apply.
Why would a Medicare claim for G0472 be denied or paid less?

These come from CMS indicators on this page, not general billing advice.

  • Its status indicator is X (statutory exclusion)—The statutory definition of physician services does not include this item. See status indicators
  • Only a technical component exists for G0472—there is no professional-component amount to bill. See billing policy

Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.

Which billing rules and modifiers apply? Copy link

Global period: what G0472's fee already covers Copy link

XXX Does not apply

The global surgery concept does not apply to this code.

Billing policy Copy link

These billing-policy indicators explain how G0472 is treated. They apply whether the code is nationally priced or carrier-priced: a restriction like "bilateral not allowed" still matters on a carrier-priced code.

Policy Value What it means
Professional/technical split 3 Technical component only. Only a technical component exists for this code—there is no corresponding professional-component amount to bill.

Can you bill it with another code? Copy link

Check a pair of codes Copy link

Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit for the pair.

See every current NCCI pair for G0472 →

Why a G0472 line may not pay separately Copy link

CMS publishes no separately payable amount for G0472 in this release, so reconciling the line means establishing which status governed the date of service rather than chasing a fee-schedule difference.

What to check

  • Confirm the status that governed the date of service before working this line as a short payment—CMS publishes no separately payable fee-schedule amount for it in this release.
  • Only a technical-component amount is published for this code, so a professional charge billed on it has no fee-schedule amount behind it.
  • Reprice the line against the release, locality, setting, modifier and participation status that applied to the date of service before treating any difference as an underpayment.

Compare against G0471, G0473 and G0470: their amounts are in Related codes.

Check an actual payment Model this code in a contract

Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Medicare Physician Fee Schedule Relative Value Files (status indicator field); CMS Medicare Claims Processing Manual (Pub. 100-04).

How has it changed? Copy link

Rate history by release Copy link

National Office (non-facility) amount for G0472 across quarterly releases.

Release Status Office Facility
Q4 2026 Oct 1, 2026 – present X — —
Q3 2026 Jul 1, 2026 – Sep 30, 2026 X — —
Q2 2026 Apr 1, 2026 – Jun 30, 2026 X — —
When does this rate change?

CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

Usage and related codes Copy link

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Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q4 2022 release (effective October 2022). National baselines use GPCI 1.000 and exclude sequestration. Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero. Past releases are never edited, so these sources stay valid after CMS publishes a newer one. CMS owns the code description shown for HCPCS Level II codes. Our methodology explains sourcing, parsing, versioning, and how we cross-check claims before we publish them.

Physician relative value file (Q4 2022) · rvu22d.zip (PPRRVU22_OCT.csv row 1,754)

Cite this rate

The citation names the release, so anyone can check it even after CMS publishes a newer one.

HCPCS G0472 National PFS baseline: No national PFS rate (Q4 2022; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU22D, PPRRVU22_OCT.csv row 1,754. Localis. https://localishealth.com/hcpcs/G0472/2022/D