Key facts for G0480
- Medicare payment
- $114.43
- CLFS national limitation amount
- Coverage code
- C
- carrier judgment, so the Medicare contractor decides coverage
- Practitioner MUE
- 1
- MAI 2
- NCCI PTP pairs
- 99
- 99 hospital outpatient
- LCDs and articles
- 7 / 7
TL;DR
G0480 is a Level II code from the G section (procedures and professional services, temporary), in use since 2016: "Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed". The 2026 Q4 clinical laboratory fee schedule pays G0480 $114.43 (national limitation amount). MUE limits for G0480: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). In the NCCI PTP files v323r0 G0480 appears in 17 practitioner pairs as column 2 and 82 as column 1 (most often with 0007U, 0011U, 0051U), and in 17 hospital outpatient pairs as column 2 and 82 as column 1. 7 active LCDs and 7 billing and coding articles list G0480 across 26 states plus DC and 2 territories: L34645 (Urine Drug Testing), L35006 (Controlled Substance Monitoring and Drugs of Abuse Testing), A54799, A55001. OPPS status indicator Q4: Conditionally packaged laboratory services. HCPCS record: BETOS T1H (lab tests - other (non-Medicare fee schedule)); pricing indicator 21; type of service 5 (diagnostic laboratory). 4 other active codes open with "Drug test"; related codes: G0481, G0659, G0482, G0483.
G0480 descriptor and code status
The October 2026 HCPCS Level II file describes G0480 as “Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0480 CPT code", G0480 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.
| Field | Value |
|---|---|
| Short descriptor | Drug test def 1-7 classes |
| Added to HCPCS | 2016-01-01 |
| Last action | N (no maintenance), effective 2017-01-01 |
| Coverage code | C: carrier judgment, so the Medicare contractor decides coverage |
| Pricing indicator | 21: clinical lab fee schedule, subject to the national limitation amount |
| BETOS category | T1H: lab tests - other (non-Medicare fee schedule) |
| Type of service | 5: diagnostic laboratory |
Medicare payment for G0480
The 2026 Q4 clinical laboratory fee schedule pays G0480 $114.43 (national limitation amount). 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)
G0480 is paid at $114.43 (national limitation amount). Laboratory fee schedule payments carry no beneficiary coinsurance or deductible.
Hospital outpatient (OPPS Addendum B)
Status indicator Q4 (Conditionally packaged laboratory services), with no separate OPPS payment rate.
Medically Unlikely Edits for G0480
MUE limits for G0480: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). The practitioner MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.
| Setting | MUE (units/DOS) | MAI | CMS rationale |
|---|---|---|---|
| Practitioner services | 1 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
| Facility outpatient hospital | 1 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
The MUE lookup for G0480 shows every setting next to any other code on the same claim.
NCCI edits and add-on rules
In the practitioner PTP file v323r0, G0480 is the column-2 (bundled) code in 17 active pairs, 6% of which allow a modifier and the column-1 code in 82 (26% modifier-allowed); 16 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Mutually exclusive procedures.
| Column-1 code | Pairs |
|---|---|
| 0007U (CPT; descriptor licensed by AMA) | 1 |
| 0011U (CPT; descriptor licensed by AMA) | 1 |
| 0051U (CPT; descriptor licensed by AMA) | 1 |
| 0054U (CPT; descriptor licensed by AMA) | 1 |
| 0082U (CPT; descriptor licensed by AMA) | 1 |
| 0093U (CPT; descriptor licensed by AMA) | 1 |
| 0110U (CPT; descriptor licensed by AMA) | 1 |
| 0116U (CPT; descriptor licensed by AMA) | 1 |
| Column-2 code | Pairs |
|---|---|
| 0119U (CPT; descriptor licensed by AMA) | 1 |
| 0251U (CPT; descriptor licensed by AMA) | 1 |
| 80320 (CPT; descriptor licensed by AMA) | 1 |
| 80321 (CPT; descriptor licensed by AMA) | 1 |
| 80322 (CPT; descriptor licensed by AMA) | 1 |
| 80323 (CPT; descriptor licensed by AMA) | 1 |
| 80324 (CPT; descriptor licensed by AMA) | 1 |
| 80325 (CPT; descriptor licensed by AMA) | 1 |
In the hospital outpatient PTP file v323r0, G0480 is the column-2 (bundled) code in 17 active pairs, 6% of which allow a modifier and the column-1 code in 82 (26% modifier-allowed); 21 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Mutually exclusive procedures.
| Column-1 code | Pairs |
|---|---|
| 0007U (CPT; descriptor licensed by AMA) | 1 |
| 0011U (CPT; descriptor licensed by AMA) | 1 |
| 0051U (CPT; descriptor licensed by AMA) | 1 |
| 0054U (CPT; descriptor licensed by AMA) | 1 |
| 0082U (CPT; descriptor licensed by AMA) | 1 |
| 0093U (CPT; descriptor licensed by AMA) | 1 |
| 0110U (CPT; descriptor licensed by AMA) | 1 |
| 0116U (CPT; descriptor licensed by AMA) | 1 |
| Column-2 code | Pairs |
|---|---|
| 0119U (CPT; descriptor licensed by AMA) | 1 |
| 0251U (CPT; descriptor licensed by AMA) | 1 |
| 80320 (CPT; descriptor licensed by AMA) | 1 |
| 80321 (CPT; descriptor licensed by AMA) | 1 |
| 80322 (CPT; descriptor licensed by AMA) | 1 |
| 80323 (CPT; descriptor licensed by AMA) | 1 |
| 80324 (CPT; descriptor licensed by AMA) | 1 |
| 80325 (CPT; descriptor licensed by AMA) | 1 |
G0480 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 G0480 against a second code to see whether the pair bundles and whether a modifier can separate the services.
Medicare coverage policies for G0480
7 active Local Coverage Determinations and 7 billing and coding articles list G0480. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.
- Urine Drug Testing, LCD L34645 · Wisconsin Physicians Service Insurance Corporation
- Controlled Substance Monitoring and Drugs of Abuse Testing (L35006) · Novitas Solutions, Inc.
- LCD L35724: Urine Drug Testing · Palmetto GBA
- L36029 Urine Drug Testing · CGS Administrators, LLC
- L36393 Controlled Substance Monitoring and Drugs of Abuse Testing · First Coast Service Options, Inc.
- L36668 Urine Drug Testing · Noridian Healthcare Solutions, LLC
- L39611 Urine Drug Testing · Wellpoint Federal
| Article | Title | Contractor(s) | Related LCD |
|---|---|---|---|
| A54799 | Billing and Coding: Urine Drug Testing | Palmetto GBA | L35724 |
| A55001 | Billing and Coding: Urine Drug Testing | Noridian Healthcare Solutions, LLC | L36668, L39586 |
| A56645 | Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing | Novitas Solutions, Inc. | L35006 |
| A56818 | Billing and Coding: Urine Drug Testing | CGS Administrators, LLC | L36029 |
| A56915 | Billing and Coding: Urine Drug Testing | Wisconsin Physicians Service Insurance Corporation | L34645, L39622 |
| A57077 | Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing | First Coast Service Options, Inc. | L36393 |
| A59416 | Billing and Coding: Urine Drug Testing | Wellpoint Federal | L39611 |
Denials to expect on G0480
the diagnosis or documentation does not meet the LCD or billing article that lists G0480
the modifier reported is inconsistent with the code
the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier
Where QuickIntell fits for G0480 claims
QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0480 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.
Frequently asked questions: HCPCS G0480
What does HCPCS code G0480 describe?
"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed" (short descriptor "Drug test def 1-7 classes"), in the G section (procedures and professional services, temporary). Added 2016-01-01; last action N (no maintenance) effective 2017-01-01.
Is G0480 a CPT code?
No: CMS maintains G0480 in HCPCS Level II, while the AMA maintains CPT. People do search "G0480 CPT code", and it goes in the same procedure-code field.
What does Medicare pay for G0480?
The 2026 Q4 clinical laboratory fee schedule pays G0480 $114.43 (national limitation amount).
How many units of G0480 can be billed per day?
MUE limits for G0480: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). 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 G0480?
Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 7 active LCDs and 7 billing and coding articles list G0480 across 26 states plus DC and 2 territories: L34645 (Urine Drug Testing), L35006 (Controlled Substance Monitoring and Drugs of Abuse Testing), A54799, A55001.
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.
- HCPCS Level II alpha-numeric file, October 2026Version October 2026 · effective 2026-10-01 · file HCPC2026_OCT_ANWEB_09232026.txtSHA-256 c25240c63108756d…
- Medicare PFS national relative value file RVU26D (non-QPP), October 2026Version RVU26D, released 2026-08-26 · effective 2026-10-01 · file PPRRVU2026_Oct_nonQPP.csvSHA-256 4d0d3f19bd954ffc…
- Medicare PFS national relative value file RVU26D (qualifying APM participants), October 2026Version RVU26D, released 2026-08-26 · effective 2026-10-01 · file PPRRVU2026_Oct_QPP.csvSHA-256 59d3734704853936…
- Clinical Laboratory Fee Schedule public use file, 2026 fourth quarter (26CLABQ4)Version 26CLABQ4 (CY2026 Q4) · effective 2026-10-01 · file PUF_CLFS_CY2026_Q4V1.csvSHA-256 fcfec34526c44390…
- OPPS Addendum B, October 2026Version October 2026 · effective 2026-10-01 · file 508-compliant-version-2026_October_Web_Addendum_B.09.28.26.csvSHA-256 6ad7393a318bf1b9…
- Integrated Outpatient Code Editor v27.3 data tables: status and payment indicatorsVersion I/OCE v27.3 (October 2026) · effective 2026-10-01 · file Data_Status_Indicator.txtSHA-256 78f119ef0a435351…
- NCCI MUE table, practitioner services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_PractitionerServices_Eff_10-01-2026.csvSHA-256 ef038efaf902b7bd…
- NCCI MUE table, facility services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_OutpatientHospitalServices_Eff_10-01-2026.csvSHA-256 3af9f4e99cc587e2…
- NCCI MUE table, dme services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_DMESupplierServices_Eff_10-01-2026.csvSHA-256 6fa4fbba852f7b74…
- NCCI PTP edits, practitioner, v323r0 (four files)Version v323r0 (2026 Q4) · effective 2026-10-01 · file ccipra-v323r0-f1.TXTSHA-256 7793c0b6686c1e22…
- NCCI PTP edits, hospital outpatient, v323r0 (four files)Version v323r0 (2026 Q4) · effective 2026-10-01 · file ccioph-v323r0-f1.txtSHA-256 063f41b91ef9faa2…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-10-08 · effective 2026-10-04 · file article.csvSHA-256 5e95c4a8ac3664be…
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-10-08 · effective 2026-10-04 · file lcd.csvSHA-256 9aee1bd7f14056b0…
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.