2025 HCPCS code G0475
(Active) Effective Date: N/A Revision Date: N/A Laboratory Services - Laboratory Tests Other Services Feed
HIV antigen/antibody combination immunoassay screening test.
Modifiers may be applicable depending on the circumstances of the service. Consult the CMS National Correct Coding Initiative (NCCI) edits and payer-specific guidelines for appropriate modifier use.
Medical necessity for G0475 is established when a physician orders the test based on the patient's clinical presentation, risk factors for HIV infection, or as part of routine screening in specific populations (e.g., pregnant women).
The clinical responsibility lies with the laboratory personnel who perform the technical aspects of the HIV antigen/antibody combination immunoassay, including specimen processing, assay execution, and result interpretation. The ordering physician is responsible for medical decision-making based on the test results, including ordering confirmatory tests if the screening test is positive.
In simple words: This lab test checks for HIV, the virus that causes AIDS.It looks for both parts of the virus and the body's response to it. The lab technician does the test, and a positive result means further tests are needed to confirm if someone has HIV.
This HCPCS code encompasses the performance of a screening test for Human Immunodeficiency Virus (HIV) using a combination immunoassay technique.The test analyzes a patient specimen (e.g., serum) to detect both HIV antigens (like p24) and antibodies to HIV-1 and HIV-2.Methods employed include enzyme immunoassay (EIA), enzyme-linked immunosorbent assay (ELISA), and immunochemiluminometric assay (IMCA). The lab analyst performs all technical aspects of the assay, from specimen preparation to result interpretation (positive, negative, or semi-quantitative).A positive result necessitates confirmatory testing.
Example 1: A patient presents with symptoms suggestive of HIV infection.The physician orders an HIV antigen/antibody combination immunoassay (G0475) as a screening test.The lab performs the test, and the results are reported to the physician., A pregnant woman undergoes routine prenatal testing, which includes an HIV screening test (G0475). The lab result is negative, reassuring the physician and the patient., An individual who has engaged in high-risk behaviors requests HIV testing. The physician orders a screening test (G0475). A positive result prompts confirmatory testing to determine if the individual has HIV infection.
* Patient demographics and relevant identifying information.* Physician's order specifying the HIV antigen/antibody combination immunoassay.* Specimen collection date and time.* Information about the specimen type (e.g., serum).* Lab report with detailed results (including the method used).* Note indicating any additional testing (confirmatory tests if positive).
** Specific immunoassay methodologies used may vary between labs. Accurate documentation of the method used is important.G0475 represents a complete screening test, which includes the technical component.Additional billing for separate specimen collection may be allowed based on payer rules.Always verify the most current payer coverage and coding guidelines before billing.
- Payment Status: Active
- Modifier TC rule: The technical component (TC) modifier does not apply to this code as it is a complete laboratory service.
- Specialties:Infectious Disease, Internal Medicine, Obstetrics/Gynecology, Public Health
- Place of Service:Office, Hospital (Inpatient/Outpatient), Laboratory