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HCPCS G0433 · Level II · G code

G0433: Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, HCPCS Level II G code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); Clinical Laboratory Fee Schedule: 26CLABQ4 (CY2026 Q4) (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and Clinical Laboratory Fee Schedule and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file.

Key facts for G0433

Medicare payment
$18.29
CLFS national limitation amount
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
1
MAI 2
OPPS status
SI A
Services not paid under OPPS; paid under fee schedule or other payment system
NCCI PTP pairs
6
6 hospital outpatient
LCDs and articles
0 / 0

TL;DR

CMS describes HCPCS G0433, added in 2009, as "Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening". The 2026 Q4 clinical laboratory fee schedule pays G0433 $18.29 (national limitation amount), also listed with QW. CMS caps G0433 at practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. In the NCCI PTP files v323r0 G0433 appears in 3 practitioner pairs as column 2 and 3 as column 1 (most often with 87389, 87806, G0475), and in 3 hospital outpatient pairs as column 2 and 3 as column 1. G0433 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code C (carrier judgment, so the Medicare contractor decides coverage) and any NCD. OPPS status indicator A: Services not paid under OPPS; paid under fee schedule or other payment system. HCPCS record: BETOS T1H (lab tests - other (non-Medicare fee schedule)); pricing indicator 21; type of service 9 (other medical items or services). Nearby codes: G0432, G0429, G0438, G0427.

G0433 descriptor and code status

The October 2026 HCPCS Level II file describes G0433 as “Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes.

HCPCS file attributes of G0433
FieldValue
Short descriptorElisa hiv-1/hiv-2 screen
Added to HCPCS2009-12-08
Last actionN (no maintenance), effective 2013-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator21: clinical lab fee schedule, subject to the national limitation amount
BETOS categoryT1H: lab tests - other (non-Medicare fee schedule)
Type of service9: other medical items or services

Medicare payment for G0433

The 2026 Q4 clinical laboratory fee schedule pays G0433 $18.29 (national limitation amount), also listed with QW. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status X: statutory exclusion: not a physician service under the fee schedule. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).

Clinical Laboratory Fee Schedule (26CLABQ4)

G0433 is paid at $18.29 (national limitation amount); the file also lists it with modifier QW (a CLIA-waived test). Laboratory fee schedule payments carry no beneficiary coinsurance or deductible.

Hospital outpatient (OPPS Addendum B)

Status indicator A (Services not paid under OPPS; paid under fee schedule or other payment system), with no separate OPPS payment rate.

Medically Unlikely Edits for G0433

CMS caps G0433 at practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. The practitioner MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.

MUE values for G0433 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction
Facility outpatient hospital12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction

The MUE lookup for G0433 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, G0433 is the column-2 (bundled) code in 3 active pairs, 0% of which allow a modifier and the column-1 code in 3 (67% modifier-allowed); 0 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Mutually exclusive procedures.

Column-1 codes most often paired with G0433 (practitioner)
Column-1 codePairs
87389 (CPT; descriptor licensed by AMA)1
87806 (CPT; descriptor licensed by AMA)1
G0475 Hiv combination assay1
Column-2 codes bundled into G0433 (practitioner)
Column-2 codePairs
86701 (CPT; descriptor licensed by AMA)1
86702 (CPT; descriptor licensed by AMA)1
86703 (CPT; descriptor licensed by AMA)1

In the hospital outpatient PTP file v323r0, G0433 is the column-2 (bundled) code in 3 active pairs, 0% of which allow a modifier and the column-1 code in 3 (67% modifier-allowed); 0 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Mutually exclusive procedures.

Column-1 codes most often paired with G0433 (hospital outpatient)
Column-1 codePairs
87389 (CPT; descriptor licensed by AMA)1
87806 (CPT; descriptor licensed by AMA)1
G0475 Hiv combination assay1
Column-2 codes bundled into G0433 (hospital outpatient)
Column-2 codePairs
86701 (CPT; descriptor licensed by AMA)1
86702 (CPT; descriptor licensed by AMA)1
86703 (CPT; descriptor licensed by AMA)1

G0433 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check G0433 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0433

No current LCD or billing and coding article lists G0433. The HCPCS coverage code C means carrier judgment, so the Medicare contractor decides coverage, and any National Coverage Determination for the service still applies.

Denials to expect on G0433

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units of G0433 exceed the practitioner MUE of 1 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for G0433 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0433 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS G0433

What does HCPCS code G0433 describe?

"Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening" (short descriptor "Elisa hiv-1/hiv-2 screen"), in the G section (procedures and professional services, temporary). Added 2009-12-08; last action N (no maintenance) effective 2013-01-01.

Is G0433 a CPT code?

It is not. G0433 belongs to the G section (procedures and professional services, temporary) of HCPCS Level II, the CMS code set, not to AMA CPT.

What does Medicare pay for G0433?

The 2026 Q4 clinical laboratory fee schedule pays G0433 $18.29 (national limitation amount), also listed with QW.

How many units of G0433 can be billed per day?

CMS caps G0433 at practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. For the practitioner MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover G0433?

G0433 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code C (carrier judgment, so the Medicare contractor decides coverage) and any NCD.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.