HCPCS code G0472: Hepatitis C screen, high-risk and covered indications2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Reports a hepatitis C antibody screening test for an individual at high risk or with another covered indication.
Medicare pays $46.35 for G0472 under the 2026 Clinical Laboratory Fee Schedule: one national amount, the same in every state and setting.
Medicare lab fee · CLFS 2026 Q4
National CLFS amount
$46.35
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2020
- Unchanged
- QW · CLIA-waived test
- $46.35
Medicare pays the lesser of the lab’s charge and this amount. Patients usually owe no Part B deductible or coinsurance for covered clinical lab tests.
On this page 8 sections
What G0472 covers
G0472 represents screening for antibodies to hepatitis C virus (HCV) in an individual at high risk or with another covered indication. The antibody result indicates whether the person has been exposed to HCV; it does not by itself establish current infection. A reactive screen may be followed by HCV RNA testing to assess for current infection. Clinical laboratories perform and report the assay for Medicare beneficiaries receiving covered screening.
When the test is performed as the CLIA-waived version, modifier QW identifies that version for a site holding a CLIA certificate of waiver. Medicare pays G0472 only through the CLFS, at one national amount across states and localities, with no office-versus-facility payment difference. The 2026 national CLFS amount is $46.35, unchanged since 2020.
This summary was written with AI assistance from CMS Clinical Laboratory Fee Schedule data. Amounts on this page come directly from CMS files.
How Medicare pays G0472
Clinical lab tests aren’t priced like physician services. They’re paid from their own fee schedule, with its own rules. See the whole lab fee schedule.
One national amount
CMS sets a single Clinical Laboratory Fee Schedule amount for G0472. There’s no geographic (GPCI) adjustment, so it pays the same in every state and payment locality.
No office or facility rate
Lab tests aren’t built from relative value units, so there’s no office and facility split: the place of service doesn’t change the CLFS amount.
Updated every quarter
CMS republishes the CLFS each quarter. New tests, often proprietary laboratory analyses (PLA codes), join during the year; existing amounts are updated each January.
Excluded from the physician fee schedule
The physician fee schedule lists G0472 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists G0472 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $46.35.
G0472 on the lab fee schedule since 2020
G0472 · CLFS 2026 Q4 (current)
$46.35
Unchanged since Jan 1, 2020
27 quarterly CLFS releases on file, first CLFS 2020 Q1. A code missing from a quarter wasn’t on that release.
G0472 compared with similar tests
- 86803Hepatitis C antibodyScreening antibody assay$14.27
- G0472 is the Medicare screening code for high-risk individuals and other covered indications. 86803 is the general HCV antibody test code for other testing circumstances.
- 87522HCV viral loadQuantitative RNA$42.84
- G0472 detects HCV antibodies as a screening test. 87522 measures HCV RNA and is used to assess for current infection.
- G0475HIV screenAntigen/antibody combination$24.08
- G0472 screens for hepatitis C antibodies; G0475 is an HIV combination assay, not an HCV test.
G0472 billing questions
When should G0472 be used instead of 86803?
G0472 identifies the Medicare hepatitis C antibody screening service for a high-risk individual or another covered indication. 86803 is the general HCV antibody test code used in other testing circumstances.
Does a reactive antibody result confirm current hepatitis C infection?
No. Antibodies can remain after an infection has cleared, so HCV RNA testing such as 87522 may be performed to assess for current infection.
When is modifier QW appropriate?
Use QW when the screening is performed as the CLIA-waived version at a site holding a CLIA certificate of waiver.
How does Medicare pay G0472?
Medicare pays the test through the CLFS using one national amount, without geographic or office-versus-facility payment adjustments.
Is G0472 paid under the physician fee schedule?
No. Medicare pays the test only through the CLFS.
Where this amount comes from
FeeBase reads lab amounts directly from the CMS Clinical Laboratory Fee Schedule file for the quarter: one row per code, with its payment indicator and national amount. Contractor-priced tests are labeled, never given a made-up amount. Amounts are Medicare payment limits, not a patient’s bill or a commercial rate.
CMS CLFS 2026 Q4 · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file line behind this amount
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