HCPCS code G0480: Definitive drug test, one to seven classes2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Reports definitive drug testing that identifies individual drugs in one to seven classes per day, including metabolites when tested.
Medicare pays $114.43 for G0480 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
$114.43
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
- CMS updates
- Quarterly
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 G0480 covers
G0480 reports definitive drug testing that identifies individual drugs and can distinguish structural isomers. Methods may include gas or liquid chromatography with mass spectrometry; the service is not an immunoassay screen. Testing may be qualitative or quantitative and may involve specimens from any source. It is commonly used when clinicians need specific drug identification, such as to clarify a presumptive result or assess medication or substance exposure during care for pain or substance use.
Report the code once per day for testing across one to seven drug classes, including metabolites when performed. Specimen validity testing is included. G0481, G0482, and G0483 represent higher class-count tiers. Medicare pays G0480 from the CLFS at one national amount, with no locality or office/facility adjustment; the 2026 national CLFS amount is $114.43, unchanged since 2020. The test is paid only from the CLFS, not 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 G0480
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 G0480. 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 G0480 with status X (excluded by statute), so the test itself is paid only from the CLFS.
G0480 on the lab fee schedule since 2020
G0480 · CLFS 2026 Q4 (current)
$114.43
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.
G0480 compared with similar tests
- G0481Definitive drug test8–14 drug classes$156.59
- G0481 applies when definitive testing covers eight to 14 drug classes. G0480 is the tier for one to seven classes.
- G0482Definitive drug test15 to 21 classes$198.74
- G0482 applies to definitive testing of 15 to 21 drug classes; G0480 applies to one to seven.
- 80307Drug screenChemistry analyzer$62.14
- 80307 reports presumptive instrument-based drug screening. G0480 reports definitive identification of individual drugs across one to seven classes.
G0480 billing questions
When is G0480 the appropriate definitive testing tier?
Use G0480 when definitive testing covers one to seven drug classes for the day. Choose a higher G048x tier when the number of classes tested falls in that tier.
How is the class count determined?
The tier is based on the number of drug classes tested, with metabolites included when performed. Report the service per day.
Is specimen validity testing separately reported?
Specimen validity testing is included in G0480. Do not report it separately as part of this service.
How does G0480 differ from a presumptive drug screen?
G0480 identifies individual drugs using definitive analytical methods. Presumptive testing uses a screening method and does not provide the same definitive identification.
Does Medicare pay G0480 under the physician fee schedule?
No. Medicare pays this test only under the CLFS, at one national amount that applies across localities and settings.
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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