G0435 — Infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, screening
G0435 is a HCPCS Level II code for infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, screening. It belongs to the Procedures and Professional Services (Temporary) section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusX
Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of G0435 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 1 unit MAI 2 — Date of Service Edit: Policy · Code Descriptor / CPT Instruction
- outpatient
- 1 unit MAI 2 — Date of Service Edit: Policy · Code Descriptor / CPT Instruction
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for G0435
- Long descriptor
- Infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, screening
- Short descriptor
- Oral hiv-1/hiv-2 screen
- Added
- December 8, 2009
- BETOS
- T1H
- Pricing indicator
- 21 — Clinical lab fee schedule
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Price subject to the national limitation amount.
Codes adjacent to G0435
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G0435 is not quite right, the correct code is very often within a few positions of it.
- G0426Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth
- G0427Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth
- G0428Collagen meniscus implant procedure for filling meniscal defects (e.g., cmi, collagen scaffold, menaflex)
- G0429Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (lds) (e.g., as a result of highly active antiretroviral therapy)
- G0431Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounterterminated
- G0432Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening
- G0433Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening
- G0434Drug screen, other than chromatographic; any number of drug classes, by clia waived test or moderate complexity test, per patient encounterterminated
- G0436Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutesterminated
- G0437Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutesterminated
- G0438Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
- G0439Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
- G0442Annual alcohol misuse screening, 5 to 15 minutes
- G0443Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes
- G0444Annual depression screening, 5 to 15 minutes
- G0445High intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes
Questions about G0435
What is HCPCS code G0435?
G0435 is a HCPCS Level II code for infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, screening. It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G0435?
The CMS HCPCS file marks G0435 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is G0435 paid under the physician fee schedule?
G0435 carries PFS status code X. Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.