Does G0476 require prior authorization?

No, G0476 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for G0476?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

Verity

`G0476` — Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

When colonoscopy is performed after a positive non-invasive test: documentation of colonoscopy findings, polypectomy/pathology results, and follow-up plan is required (implied throughout text).
For CF-specific recommendations: documentation of CF diagnosis and use of CF-specific intensive bowel preparation is expected when following CF Foundation recommendations (text).

For biopsy of lower GI tract, specific specimen counts and sampling sites must be met and documented: Microscopic colitis - documentation of 8 or more biopsies with 2 or more from each of ascending, transverse, descending, and sigmoid colon; Inflammatory bowel disease (diagnosis) - documentation of 2 or more biopsies from 5 different locations, including ileum and rectum; IBD dysplasia surveillance - documentation of targeted biopsies plus 4-quadrant biopsies every 10 cm for pancolitis or segmental 4-quadrant biopsies every 10 cm limited to involved areas; Pouchitis - multiple biopsies from pouch and afferent loop documented; Acute graft-versus-host disease - flexible sigmoidoscopy: 4+ biopsies from rectum/sigmoid and 4+ from left colon; Ileocolonoscopy: 4+ biopsies from terminal ileum, ascending, transverse, descending colon, and rectum/sigmoid.

Key Coverage Criteria

Colonoscopy (considered medically necessary every 10 years for persons at average risk);
Specific biopsy procedural/collection requirements (covered when medically necessary):
Inflammatory bowel disease, diagnosis - 2 or more biopsies from 5 different locations, including the ileum and rectum;
The USPSTF recommended screening for CRC in all adults aged 50 to 75 years (A recommendation).
Constipation (K59.00 - K59.09)
Noninfective enteritis and colitis (K51.00 - K55.9)

5 Active Policies

A58232 — Billing and Coding: Screening for Cervical Cancer with Human Papillomavirus (HPV)

J09

A58216 — Billing and Coding: Screening for Cervical Cancer with Human Papillomavirus (HPV)

J12

CIGNA-A004 — Preventive Care Services - (A004)

AETNA-CPB-0516 — Colonoscopy and Colorectal Cancer Screening

AETNA-CPB-0760 — Oral Screening and Lesion Identification Systems

`G0476` — Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

5 Active Policies

Related Codes

Have a follow-up question?

G0476 — Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

5 Active Policies

Related Codes

Have a follow-up question?

`G0476` — Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test