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Q4 2026 takes effect Oct 1, 2026. CMS published it early; dates of service before then are priced under the current release — see the current HCPCS G0480 rate.

HCPCS G0480

Priced under CLFS

G0480 · PFS Q4 2026 · Upcoming

Status X is not separately payable under the PFS.

View applicable payment rules
View CMS source and method

CMS published status X (statutory exclusion) for HCPCS G0480 in the Q4 2026 Physician Fee Schedule, with no national PFS amount. These figures take effect for dates of service beginning Oct 1, 2026. Treat the blank amount as unpriced, not as $0.

PFS status evidence

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 15,291)
Inspect PFS status evidence
Code
G0480
Release
Q4 2026, revision 2
Result
Priced under CLFS

Citations

  • Establishes the PFS status (X) and the resulting pathway for this code: priced under clfs.

    Physician relative value file (PPRRVU)

    Q4 2026 · revision 2

    Latest revision of this release

    Release period: October 1 – December 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_Oct_nonQPP.csv in rvu26d-updated-08-26-2026.zip (row 15,291)
    hcpcs (col 1)
    G0480
    modifier (col 2)
    blank
    status_code (col 4)
    X

    SHA-256: 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

    Original source file

Compact facts

Why is there no national PFS amount for G0480?

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

Drug test def 1-7 classes

Payment considerations Copy link

Review the applicable inputs and payment rules. Each link opens the supporting detail on this page.

NCCI same-day edits Applies Other fee-schedule routing Applies
Other payment indicators (8)

Facility/non-facility: Not determined, Professional/technical component: Does not apply, Bilateral adjustment: Does not apply, Multiple-procedure reduction: Does not apply, Assistant/co-surgeon treatment: Does not apply, Global surgery: Does not apply, MUE behavior: Not determined, Contractor pricing: Does not apply.

Payment rules

Global period: what G0480's fee already covers Copy link

XXX Does not apply

The global surgery concept does not apply to this code.

Can you bill it with another code? 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 between it and G0480.

See every current NCCI pair for G0480 →

Billing together (NCCI edits) Copy link

NCCI Q4 2026

Based on CMS's National Correct Coding Initiative (NCCI). A few examples appear here; use the complete edit page to check a specific pair.

Not separately payable with G0480 on the same date of service—no modifier bypasses the edit (modifier indicator 0)

0007U G0480 denies
0011U G0480 denies
0051U G0480 denies

Showing 3 of 77.

Separately payable with G0480 only when an NCCI-associated modifier is appropriate and documented (modifier indicator 1)

0119U 0119U denies
0251U 0251U denies
0518U G0480 denies

Showing 3 of 22.

Modifier 59 and the X modifiers are not a universal bypass—CMS expects the most specific applicable modifier, and which one that is depends on the pair and the documented circumstances.

Check a paired code or view all 99 NCCI pairs →

Common payment questions Copy link

Why would a Medicare claim for G0480 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
  • 77 codes form NCCI pairs with G0480 carrying modifier indicator 0—no NCCI-associated modifier bypasses the edit, so billed together on the same date of service, a line of the pair denies. See billing together
  • 22 codes pair with G0480 under modifier indicator 1—separately payable only when an NCCI-associated modifier (59, or a more specific XE, XS, XP, or XU) is clinically appropriate and the documentation supports a distinct service; without one, a line of the pair denies. See billing together

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.

History

Rate history by release Copy link

National non-facility amount for G0480 across quarterly releases.

Release Status Non-facility Facility
Q4 2026 takes effect Oct 1, 2026 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 & related

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Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q4 2026 release (effective October 2026). National baselines use GPCI 1.000 and exclude sequestration. Status and payment instructions determine whether a national amount is established; blank RVUs stay blank. Releases are immutable: historical evidence remains tied to the specified release. CMS owns the code description shown for HCPCS Level II codes. Our methodology covers the depth: sourcing, parsing, versioning, and how we cross-check claims before they ship.

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 15,291)

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

Cite this rate

This citation identifies the source release, so its evidence remains reproducible after a newer release lands.

HCPCS G0480 National PFS baseline: No national PFS rate (Q4 2026; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/hcpcs/G0480/2026/D