localis

Describe a service in plain words, or type a CPT/HCPCS code.

Calculator

HCPCS G0472

Priced under CLFS

G0472 · PFS Q1 2026 · Historical

Status X is not separately payable under the PFS.

View applicable payment rules
View CMS source and method

HCPCS G0472 has no published national rate. It carries status X (statutory exclusion) in the Q1 2026 release. The statutory definition of physician services does not include this item. The blank amount means unpriced, not $0.

PFS status evidence

Physician relative value file (Q1 2026) · rvu26a-updated-12-29-2025.zip (PPRRVU2026_Jan_nonQPP.csv row 15,163)
Inspect PFS status evidence
Code
G0472
Release
Q1 2026, revision 1
Result
Priced under CLFS

Citations

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

    Physician relative value file (PPRRVU)

    Q1 2026 · revision 1

    Latest revision of this release

    Release period: January 1 – March 31, 2026

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

    Record details PPRRVU2026_Jan_nonQPP.csv in rvu26a-updated-12-29-2025.zip (row 15,163)
    hcpcs (col 1)
    G0472
    modifier (col 2)
    blank
    status_code (col 4)
    X

    SHA-256: 9a15cb9cc117f079f5bbd41819bcad7c9ebf71fa8836ee186e079bc15b3269de

    Original source file

Plain-text summary

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
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.

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.

Codes to compare

National Q1 2026 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.

Code Office Facility
G0471 Nearby medicare G-code services line in the same release — —
G0473 Priced as active rather than statutory exclusion $12.69 $10.02
G0470 Nearby medicare G-code services line in the same release — —
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).

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 →

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

Did this answer your question about HCPCS G0472?

We're building this out in the open. Tell us what you were actually trying to work out and we'll either answer you directly or build the page that does.

Did this page answer your question?

Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q1 2026 release (effective January 2026). 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 (Q1 2026) · rvu26a-updated-12-29-2025.zip (PPRRVU2026_Jan_nonQPP.csv row 15,163)

Use the (i) buttons next to each amount above for the exact row, columns, and math.

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 (Q1 2026; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/hcpcs/G0472/2026/A