HCPCS code G0475: HIV screen, antigen/antibody combination2026 Medicare lab fee · Clinical Laboratory Fee Schedule
G0475 reports an HIV antigen/antibody combination assay performed for HIV screening, rather than an antibody-only test.
Medicare pays $24.08 for G0475 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
$24.08
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
- $24.08
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 G0475 covers
The assay detects HIV antigen and antibodies as a combination screening test for HIV infection. It is used when an antigen/antibody screen is ordered, rather than an antibody-only assay. A reactive screening result may require additional testing to establish the diagnosis. Laboratories perform and report the test as a clinical laboratory service.
Report G0475 for the HIV antigen/antibody combination screening assay. CMS lists a CLIA-waived version; modifier QW marks that version for performance by a site holding a CLIA certificate of waiver. Medicare pays G0475 only through the CLFS, at one nationally set amount that is the same across localities and has no office or facility adjustment. The 2026 national CLFS amount is $24.08, unchanged since 2020. G0475 is excluded from the physician fee schedule.
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 G0475
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 G0475. 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 G0475 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists G0475 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $24.08.
G0475 on the lab fee schedule since 2020
G0475 · CLFS 2026 Q4 (current)
$24.08
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.
G0475 compared with similar tests
- 87389HIV screenHIV-1 antigen plus HIV-1/2 antibodies$24.08
- Both describe HIV antigen/antibody screening. G0475 is the HCPCS code, while 87389 is the CPT code; select the code applicable to the billing context.
- 86703HIV antibodyCombined, single result$13.71
- 86703 describes HIV-1 and HIV-2 antibody testing without an antigen component. G0475 describes a combination antigen/antibody screening assay.
- 86701HIV-1 antibodyHIV-1-specific antibody$8.89
- 86701 reports HIV-1 antibody testing alone. G0475 applies when the screening assay combines antigen and antibody detection.
G0475 billing questions
When should G0475 be used instead of an antibody-only HIV test?
Use G0475 when the screening assay combines HIV antigen and antibody detection. An antibody-only test does not describe that combination assay.
When is modifier QW appropriate?
CMS lists a CLIA-waived version of this test. Modifier QW marks that version for performance at a site holding a CLIA certificate of waiver.
Does Medicare pay G0475 under the physician fee schedule?
No. Medicare pays G0475 through the CLFS; the test is excluded from the physician fee schedule.
Does G0475 describe confirmatory testing after a reactive screen?
G0475 describes the combination screening assay. A reactive screening result may require additional testing to establish the diagnosis.
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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