G0472 HCPCS code: Hepatitis c antibody screening, for individual at high risk and other covered indication(s)
G0472 is the HCPCS Level II code for hepatitis c antibody screening, for individual at high risk and other covered indication(s). In 2024 Medicare paid an average of $45.07 per service for G0472 across 201,526 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 1 per day on outpatient hospital claims. Medicare volume rose 3% from 2022 to 2024 (195,524 to 201,526 services). In 2024, about 3,703 clinicians billed Medicare for G0472 for 201,238 beneficiaries; North Carolina, California, New Jersey accounted for 33% of services.
Code details
| Field | Value |
|---|---|
| Section | G codes — Procedures and professional services (temporary) |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 13 |
| BETOS category | P5E |
| Added | 2014-06-02 |
| Last action effective | 2016-01-01 |
Who bills G0472 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 3,703 |
| Medicare beneficiaries | 201,238 |
| States with claims | 46 |
| Share of services in top 3 states (North Carolina, California, New Jersey) | 33% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for G0472, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 195,524 | 195,243 | $45.32 | $45.32 |
| 2023 | 199,685 | 199,496 | $44.86 | $44.86 |
| 2024 | 201,526 | 201,238 | $45.07 | $45.07 |
States with the most G0472 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| North Carolina | 25,531 | $45.41 |
| California | 22,320 | $45.26 |
| New Jersey | 19,334 | $45.41 |
| Texas | 17,489 | $44.10 |
| Arizona | 12,628 | $44.41 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Code Descriptor / CPT Instruction |
| practitioner claims | 1 | Code Descriptor / CPT Instruction |
What changed for G0472
- 2014-06-02: G0472 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code G0472?
G0472 is the HCPCS Level II code for hepatitis c antibody screening, for individual at high risk and other covered indication(s). Short descriptor: "Hep c screen high risk/other".
How much does Medicare pay for G0472?
In 2024, the average Medicare payment was $45.07 per service (average allowed $45.07).
Does Medicare cover G0472?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of G0472 can be billed per day?
1 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).
Related G04 codes
- G0400 — Home sleep test (hst) with type iv portable monitor, unattended; minimum of 3 channels
- G0402 — Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
- G0403 — Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report
- G0404 — Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination
- G0405 — Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination
- G0406 — Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth
- G0407 — Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth
- G0408 — Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth
- G0409 — Social work and psychological services, directly relating to and/or furthering the patient's rehabilitation goals, each 15 minutes, face-to-face; individual (services provided by a corf-qualified social worker or psychologist in a corf)
- G0410 — Group psychotherapy other than of a multiple-family group, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes
- G0411 — Interactive group psychotherapy, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes
- G0412 — Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral or bilateral for pelvic bone fracture patterns which do not disrupt the pelvic ring includes internal fixation, when performed
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Next steps
- Run a reimbursement report for a device billed under G0472
- Watch G0472 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G0472
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.