G0481 HCPCS code: Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(es), including metabolite(s) if performed
G0481 is the HCPCS Level II code for drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(es), including metabolite(s) if performed. In 2024 Medicare paid an average of $152.42 per service for G0481 across 463,147 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 1 per day on outpatient hospital claims. Medicare volume rose 2% from 2022 to 2024 (455,064 to 463,147 services). In 2024, about 3,147 clinicians billed Medicare for G0481 for 231,172 beneficiaries; North Carolina, California, Florida accounted for 30% of services.
Code details
| Field | Value |
|---|---|
| Section | G codes — Procedures and professional services (temporary) |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 21 — Priced on the Clinical Laboratory Fee Schedule |
| BETOS category | T1H |
| Added | 2016-01-01 |
| Last action effective | 2017-01-01 |
Who bills G0481 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 3,147 |
| Medicare beneficiaries | 231,172 |
| States with claims | 47 |
| Share of services in top 3 states (North Carolina, California, Florida) | 30% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for G0481, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 455,064 | 233,928 | $153.30 | $153.30 |
| 2023 | 450,544 | 234,127 | $152.22 | $152.22 |
| 2024 | 463,147 | 231,172 | $152.42 | $152.42 |
States with the most G0481 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| North Carolina | 56,146 | $152.73 |
| California | 45,259 | $152.91 |
| Florida | 35,510 | $152.69 |
| Maryland | 31,860 | $153.04 |
| New Jersey | 28,389 | $152.80 |
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 |
Medicare policy articles for this code
- A54799: Billing and Coding: Urine Drug Testing (Palmetto GBA (MAC - Part A, MAC - Part B))
- A55001: Billing and Coding: Urine Drug Testing (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B))
- A56645: Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing (Novitas Solutions, Inc. (MAC - Part A, MAC - Part B))
- A56818: Billing and Coding: Urine Drug Testing (CGS Administrators, LLC (MAC - Part A, MAC - Part B))
- A56915: Billing and Coding: Urine Drug Testing (WPS Insurance Corporation (MAC - Part A, MAC - Part B))
- A57077: Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing (First Coast Service Options, Inc. (MAC - Part A, MAC - Part B))
- A59416: Billing and Coding: Urine Drug Testing (Wellpoint Federal (MAC - Part A, MAC - Part B))
Covered diagnoses (1,451 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| E87.21 | Acute metabolic acidosis | 7 |
| E87.22 | Chronic metabolic acidosis | 7 |
| E87.29 | Other acidosis | 7 |
| F11.20 | Opioid dependence, uncomplicated | 7 |
| F11.220 | Opioid dependence with intoxication, uncomplicated | 7 |
| F11.221 | Opioid dependence with intoxication delirium | 7 |
| F11.222 | Opioid dependence with intoxication with perceptual disturbance | 7 |
| F11.229 | Opioid dependence with intoxication, unspecified | 7 |
| F11.23 | Opioid dependence with withdrawal | 7 |
| F11.24 | Opioid dependence with opioid-induced mood disorder | 7 |
Showing 10 of 1,451. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for G0481
- 2016-01-01: G0481 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 G0481?
G0481 is the HCPCS Level II code for drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(es), including metabolite(s) if performed. Short descriptor: "Drug test def 8-14 classes".
How much does Medicare pay for G0481?
In 2024, the average Medicare payment was $152.42 per service (average allowed $152.42).
Does Medicare cover G0481?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for G0481?
Medicare policy articles that cite G0481 list 1,451 covered ICD-10-CM diagnosis codes across 7 articles. The most cited include E87.21 (Acute metabolic acidosis), E87.22 (Chronic metabolic acidosis), E87.29 (Other acidosis). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of G0481 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 G0481
- Watch G0481 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G0481
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.