2025 HCPCS code G0476
(Active) Effective Date: N/A Revision Date: N/A Laboratory Test - Infectious Agent Detection Other Services Feed
Infectious agent detection by nucleic acid (DNA or RNA); human papillomavirus (HPV), high-risk types for cervical cancer screening; must be performed in addition to a Pap test.
Modifiers may be applicable depending on the circumstances of the service; consult the current modifier guidelines.For example, modifier 59 might be used to indicate a distinct procedural service.
Medical necessity is established by the patient's age (typically between 21 and 65) and adherence to established cervical cancer screening guidelines.This includes consideration of past Pap smear results, family history, and other risk factors.
The clinical responsibility lies with the laboratory personnel who perform the HPV test.The ordering physician is responsible for medical necessity and patient counseling.
In simple words: This lab test checks for certain types of the human papillomavirus (HPV) that can cause cervical cancer.It's done along with a Pap smear to better screen for cervical cancer. The test looks for specific high-risk HPV types that increase the chance of developing cancer.
This HCPCS code, G0476, represents the laboratory procedure for detecting high-risk types of human papillomavirus (HPV) using nucleic acid (DNA or RNA) detection methods.It's specifically for cervical cancer screening and is always performed in conjunction with a Pap smear (Papanicolaou test). The test identifies high-risk HPV types such as 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68.The results are used to assess the risk of cervical cancer.This code is all-inclusive and covers the complete procedure.
Example 1: A 30-year-old woman presents for her routine annual well-woman exam, including a Pap smear and HPV test for cervical cancer screening. Code G0476 is reported along with Z11.51 (Encounter for screening for human papillomavirus) and Z01.411 (Encounter for screening for malignant neoplasm of cervix)., A 45-year-old woman with a history of abnormal Pap smears undergoes a repeat Pap smear and HPV co-testing. G0476 is used, along with appropriate ICD-10 codes reflecting her history and the screening nature of the visit., A 55-year-old woman who has been asymptomatic undergoes cervical cancer screening as part of her preventative care. This involves a Pap smear and HPV testing; G0476 is reported with Z11.51 and a secondary ICD-10 code consistent with the absence of any other diagnosis.
Documentation must include the date of the HPV test and Pap smear, the results of both tests, and the medical necessity for the screening (e.g., age, risk factors, prior abnormal findings).The documentation should also include the patient's age and risk factors for cervical cancer.
** This code is for use only in conjunction with a Pap smear.Incorrect use of this code with other tests or without a Pap smear could result in claim denials. Always verify payer-specific guidelines for coding and reimbursement.
- Payment Status: Active
- Modifier TC rule: The technical component (TC) modifier is not applicable to this code, as it represents the complete laboratory test.
- Specialties:Obstetrics and Gynecology, Pathology, Clinical Laboratory
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center, Clinical Laboratory