HCPCS Code G0475

Official Description

Hiv antigen/antibody, combination assay, screening

Short Descr	Hiv combination assay
Coverage	Carrier Priced
Pricing Indicator(s)	13 – Physician Fee Schedule - Price established by carriers (e.G., not otherwise classified, individual determination, carrier discretion)
MPI	A – Not applicable, as HCPCS priced under one methodology
Lab Cert(s)	140 – Virology
BETOS	T2D – Other tests - other
TOS Code(s)	5 – Diagnostic laboratory
Added Date	4/13/2015
Status Code	Statutory Exclusion (from MPFS, may be paid under other methodologies)
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	9 - Not Applicable
Multiple Procedures (51)	9 - Concept does not apply.
Bilateral Surgery (50)	9 - Concept does not apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	9 - Concept does not apply.
Co-Surgeons (62)	9 - Concept does not apply.
Team Surgery (66)	9 - Concept does not apply.
Diagnostic Imaging Family	99 - Concept Does Not Apply
CLIA Waived (QW)	Yes
APC Status Indicator	Service Paid under Fee Schedule or Payment System other than OPPS
MUE	1
MUE	Not applicable/unspecified.
OTS Orthotic	No

GZ	Item or service expected to be denied as not reasonable and necessary
QW	Clia waived test
90	Reference (outside) laboratory: when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number.
GA	Waiver of liability statement issued as required by payer policy, individual case
Q1	Routine clinical service provided in a clinical research study that is in an approved clinical research study
GY	Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
33	Preventive services: when the primary purpose of the service is the delivery of an evidence based service in accordance with a us preventive services task force a or b rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory), the service may be identified by adding 33 to the procedure. for separately reported services specifically identified as preventive, the modifier should not be used.
59	Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
AY	Item or service furnished to an esrd patient that is not for the treatment of esrd
CC	Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
FP	Service provided as part of family planning program
GW	Service not related to the hospice patient's terminal condition
KX	Requirements specified in the medical policy have been met
Q0	Investigational clinical service provided in a clinical research study that is in an approved clinical research study
XS	Separate structure, a service that is distinct because it was performed on a separate organ/structure