Skip to main content
HCPCS G0452 · Level II · G code

G0452: Molecular pathology procedure; physician interpretation and report, 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); 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); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file 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; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for G0452

Medicare payment
$46.76
PFS non-facility, national
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
6
MAI 3
OPPS status
SI B
Non-allowed item or service for OPPS
NCCI PTP pairs
511
511 hospital outpatient
LCDs and articles
4 / 2

TL;DR

G0452 is a Level II code from the G section (procedures and professional services, temporary), in use since 2013: "Molecular pathology procedure; physician interpretation and report". Under the 2026 physician fee schedule (October release) G0452 carries 0.91 work, 0.47 practice-expense and 0.02 malpractice RVUs, which at $33.4009 per RVU pays $46.76 non-facility and no facility amount facility before the locality adjustment. Qualifying APM participants get $46.99 at $33.5675. Its 2026 Q4 MUEs per date of service: practitioner 6 (MAI 3, Clinical: Data); hospital outpatient 1 (MAI 3, Nature of Service/Procedure). In the NCCI PTP files v323r0 G0452 appears in 498 practitioner pairs as column 2 and 13 as column 1 (most often with 0001U, 0004M, 0005U), and in 506 hospital outpatient pairs as column 2 and 5 as column 1. 4 active LCDs and 2 billing and coding articles list G0452 across 5 states plus DC and 2 territories: L35062 (Biomarkers Overview), L39365 (Genetic Testing in Oncology: Specific Tests), A58917, A58918. OPPS status indicator B: Non-allowed item or service for OPPS. HCPCS record: BETOS T2D (other tests - other); pricing indicator 13; type of service 1 (medical care). Nearby codes: G0451, G0453, G0454, G0448.

G0452 descriptor and code status

The October 2026 HCPCS Level II file describes G0452 as “Molecular pathology procedure; physician interpretation and report”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0452 CPT code", G0452 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of G0452
FieldValue
Short descriptorMolecular pathology interpr
Added to HCPCS2013-01-01
Last actionN (no maintenance), effective 2013-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator13: physician fee schedule, priced by the contractor
BETOS categoryT2D: other tests - other
Type of service1: medical care

Medicare payment for G0452

Under the 2026 physician fee schedule (October release) G0452 carries 0.91 work, 0.47 practice-expense and 0.02 malpractice RVUs, which at $33.4009 per RVU pays $46.76 non-facility and no facility amount facility before the locality adjustment. Qualifying APM participants get $46.99 at $33.5675. 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 A: active: paid separately under the physician fee schedule when covered. Global period XXX (global surgery concept does not apply); PC/TC indicator 1 (diagnostic test with professional (26) and technical (TC) components).

PFS relative values and national payment for G0452
ComponentNon-facilityFacility
Work RVU0.910.91
Practice expense RVU0.47NA
Malpractice RVU0.020.02
Total RVUs1.40NA
National payment (CF $33.4009)$46.76n/a
Qualifying APM participant (CF $33.5675)$46.99n/a
  • Multiple procedures (modifier 51): no multiple-procedure reduction
  • Bilateral (modifier 50): 150% bilateral adjustment does not apply
  • Assistant at surgery: assistant at surgery paid only with documentation; co-surgeons: co-surgeons not permitted; team surgery: team surgeons not permitted
  • Physician supervision of diagnostic procedures: supervision concept does not apply

G0452 also carries 26 and TC rows in the RVU file, priced separately from the global service.

Component rows for G0452
ModifierStatusNon-facilityFacility
26A$43.76$43.76
TCA$3.01n/a

Hospital outpatient (OPPS Addendum B)

Status indicator B (Non-allowed item or service for OPPS), with no separate OPPS payment rate.

Medically Unlikely Edits for G0452

Its 2026 Q4 MUEs per date of service: practitioner 6 (MAI 3, Clinical: Data); hospital outpatient 1 (MAI 3, Nature of Service/Procedure). The practitioner MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for G0452 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services63 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital13 Date of Service Edit: ClinicalNature of Service/Procedure

The MUE lookup for G0452 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, G0452 is the column-2 (bundled) code in 498 active pairs, 100% of which allow a modifier and the column-1 code in 13 (100% modifier-allowed); 36 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Misuse of Column Two code with Column One code.

Column-1 codes most often paired with G0452 (practitioner)
Column-1 codePairs
0001U (CPT; descriptor licensed by AMA)1
0004M (CPT; descriptor licensed by AMA)1
0005U (CPT; descriptor licensed by AMA)1
0006M (CPT; descriptor licensed by AMA)1
0007M (CPT; descriptor licensed by AMA)1
0007U (CPT; descriptor licensed by AMA)1
0008U (CPT; descriptor licensed by AMA)1
0009U (CPT; descriptor licensed by AMA)1
Column-2 codes bundled into G0452 (practitioner)
Column-2 codePairs
0417U (CPT; descriptor licensed by AMA)1
0422U (CPT; descriptor licensed by AMA)1
0426U (CPT; descriptor licensed by AMA)1
0432U (CPT; descriptor licensed by AMA)1
0434U (CPT; descriptor licensed by AMA)1
0435U (CPT; descriptor licensed by AMA)1
0437U (CPT; descriptor licensed by AMA)1
0438U (CPT; descriptor licensed by AMA)1

In the hospital outpatient PTP file v323r0, G0452 is the column-2 (bundled) code in 506 active pairs, 100% of which allow a modifier and the column-1 code in 5 (100% modifier-allowed); 36 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Misuse of Column Two code with Column One code.

Column-1 codes most often paired with G0452 (hospital outpatient)
Column-1 codePairs
0001U (CPT; descriptor licensed by AMA)1
0004M (CPT; descriptor licensed by AMA)1
0005U (CPT; descriptor licensed by AMA)1
0006M (CPT; descriptor licensed by AMA)1
0007M (CPT; descriptor licensed by AMA)1
0007U (CPT; descriptor licensed by AMA)1
0008U (CPT; descriptor licensed by AMA)1
0009U (CPT; descriptor licensed by AMA)1
Column-2 codes bundled into G0452 (hospital outpatient)
Column-2 codePairs
80503 (CPT; descriptor licensed by AMA)1
80504 (CPT; descriptor licensed by AMA)1
80505 (CPT; descriptor licensed by AMA)1
80506 (CPT; descriptor licensed by AMA)1
88291 (CPT; descriptor licensed by AMA)1

G0452 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 G0452 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0452

4 active Local Coverage Determinations and 2 billing and coding articles list G0452. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Billing and Coding Articles listing G0452
ArticleTitleContractor(s)Related LCD
A58917Billing and Coding: Molecular Pathology and Genetic TestingNovitas Solutions, Inc.L35062, L39364, L39365, L39667
A58918Billing and Coding: Molecular Pathology and Genetic TestingFirst Coast Service Options, Inc.L34519, L39366, L39367, L39668

Denials to expect on G0452

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists G0452

CARC 151 · N362

units of G0452 exceed the practitioner MUE of 6 per date of service

CARC 4

the 26 or TC modifier does not fit the component billed

CARC 16

the claim lacks the description, invoice or pricing detail a contractor-priced code needs

Where QuickIntell fits for G0452 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0452 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 G0452

What does HCPCS code G0452 describe?

"Molecular pathology procedure; physician interpretation and report" (short descriptor "Molecular pathology interpr"), in the G section (procedures and professional services, temporary). Added 2013-01-01.

Is G0452 a CPT code?

No. G0452 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set. Searches for "G0452 CPT code" mean this Level II code.

What does Medicare pay for G0452?

Under the 2026 physician fee schedule (October release) G0452 carries 0.91 work, 0.47 practice-expense and 0.02 malpractice RVUs, which at $33.4009 per RVU pays $46.76 non-facility and no facility amount facility before the locality adjustment. Qualifying APM participants get $46.99 at $33.5675.

How many units of G0452 can be billed per day?

Its 2026 Q4 MUEs per date of service: practitioner 6 (MAI 3, Clinical: Data); hospital outpatient 1 (MAI 3, Nature of Service/Procedure). For the practitioner MUE (MAI 3), units above 6 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover G0452?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 4 active LCDs and 2 billing and coding articles list G0452 across 5 states plus DC and 2 territories: L35062 (Biomarkers Overview), L39365 (Genetic Testing in Oncology: Specific Tests), A58917, A58918.

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.