G0567 Hepatitis C Screen (HCPCS) Reimbursement | OpenPayer

Summary & Overview

HCPCS G0567: Hepatitis C Nucleic Acid Screening, Amplified Probe Technique

HCPCS Level II code G0567 represents a molecular screening test for hepatitis C virus (HCV) that detects viral DNA or RNA using an amplified probe technique. This screening-level nucleic acid detection service is clinically important for identifying current HCV infection, informing linkage to care, and guiding public health surveillance. Nationally, HCV screening by nucleic acid methods is a key component of viral hepatitis control and management.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for nucleic acid-based HCV screening, expectations for typical service location (clinical or outpatient laboratory), and a summary of what to look for in payer coverage and coding workflows. The publication outlines benchmarks and relevant policy considerations where available and flags areas where input data are not provided.

This summary is intended for clinicians, billing professionals, and policy analysts seeking a concise reference to the HCPCS Level II code G0567, its clinical purpose, and the payer landscape to consider when evaluating laboratory screening strategies for hepatitis C.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG0567HCPCS Level IIhepatitis Cnucleic acid detectionmolecular diagnosticlaboratory testinginfectious disease screening

Billing Code Overview

HCPCS Level II code G0567 describes infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, screening, amplified probe technique. The service is a molecular diagnostic screen for hepatitis C virus (HCV) that uses amplified probe methods to detect viral nucleic acid. Typical service type is infectious disease molecular laboratory testing and the typical site of service is clinical laboratory or outpatient laboratory setting.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 38-year-old patient presents to an outpatient primary care clinic for routine screening after reporting a history of prior injection drug use and a recent episode of possible occupational blood exposure. The clinician documents risk factors for hepatitis C virus (HCV) infection and orders screening by nucleic acid amplification testing to detect HCV RNA using an amplified probe technique (G0567). A phlebotomy technician collects a blood specimen; the specimen is labeled and transported to the clinic’s affiliated molecular diagnostics laboratory. The laboratory performs an amplified probe-based nucleic acid detection assay for hepatitis C viral RNA and reports a qualitative positive/negative result and, if part of the assay workflow, reflexes to a quantitative HCV RNA test per facility protocol.

Typical workflow steps:

Patient encounter and risk assessment by clinician.
Order placed for infectious agent detection by nucleic acid, hepatitis C screening, amplified probe technique (G0567).
Specimen collection by nursing/phlebotomy staff in the outpatient clinic or community screening site.
Transport to clinical laboratory (on-site or reference lab) with appropriate chain-of-custody and handling for molecular testing.
Laboratory performs amplified probe nucleic acid assay and returns results to ordering clinician; positive results prompt linkage to confirmatory testing and treatment pathways.

Typical site of service: outpatient clinic, community screening site, federally qualified health center, or outpatient laboratory collection site.

Coding Specifications

HCPCS G8428: Medication List Not Documented as Obtained/Reviewed

HCPCS-G2215-TAKE-HOME-NASAL-NALOXONE-2-PACK-4MG

HCPCS G2215: Take-Home Nasal Naloxone 2-Pack

HCPCS-G9930-COMFORT-CARE-ONLY

HCPCS G9930: Patients Receiving Comfort Care Only

HCPCS-G9732-PATIENT-REFUSED-TO-PARTICIPATE

HCPCS G9732: Patient Refused to Participate

HCPCS-G8908-PATIENT-BURN-DOCUMENTED-PRIOR-TO-DISCHARGE

HCPCS G8908: Patient Documented to Have Received a Burn Prior to Discharge

HCPCS-G9618-UTERINE-MALIGNANCY-SCREENING-ENDOMETRIAL-SAMPLING

HCPCS G9618: Uterine Malignancy Screening or Endometrial Sampling

HCPCS-G9830-HER2-NEU-POSITIVE-BIOMARKER-STATUS

HCPCS G9830: Her-2/neu Positive Status

HCPCS-G9888-WEIGHT-LOSS-MAINTENANCE-MONTHS-7-12-5-PERCENT

HCPCS G9888: Maintenance 5% Weight Loss from Baseline (Months 7-12)

HCPCS-G8980-MOBILITY-WALKING-MOVING-AROUND-DISCHARGE-ASSESSMENT

HCPCS G8980: Mobility — Walking & Moving Around, Discharge Assessment

HCPCS-G9413-CIED-INFECTION-DEVICE-REMOVAL-OR-REVISION

HCPCS G9413: CIED Infection Requiring Device Removal or Surgical Revision

Showing 1–10 of 1996

Modifier	Description	When to Use
`00`	No modifier — standard claim submission	Use on routine claims when no special modifier applies.
`22`	Increased procedural services	Use when documentation supports substantially greater effort or complexity for specimen collection or coordination beyond typical HCV screening.
`23`	Unusual anesthesia	Rarely applicable; use only if medically necessary anesthesia was provided for specimen collection and is supported by documentation.
`52`	Reduced services	Use when the test was partially reduced or not fully performed as described in full procedure.
`53`	Discontinued procedure	Use if the specimen collection or testing was started but discontinued for reasons documented in the medical record.
`55`	Postoperative management only	Not typically applicable; may be used per payer guidance if only post-procedure services are billed.
`56`	Preoperative management only	Not typically applicable; use only per payer rules when only preop management is billed.
`62`	Two surgeons	Not applicable to this laboratory procedure except in extraordinary multidisciplinary specimen procedures; use only with supporting documentation.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Not applicable for this lab test; avoid use unless payer requires for nonphysician billing context.
`CO`	Items or services furnished as a result of insulin-related illness (specific payer use)	Use only when payer-specific rules require; otherwise not commonly applied to this screening test.
`CQ`	Service furnished by a CRNA with medical direction by a physician — Medicare	Not applicable to this procedure except in extraordinary circumstances.
`FX`	Partial modifier for distinct procedural circumstances (payer-specific)	Use per payer policy when partial modifier coding is required for split billing of lab components.
`FY`	Clinical trial related (investigational device exemption)	Use when test is part of an approved clinical trial requiring this modifier.
`QW`	CLIA-waived test performed in waived setting	Use when the HCV nucleic acid assay is CLIA-waived and performed in a waived point-of-care setting.
`QX`	CRNA service - payment under Part B to CRNA	Not applicable in routine lab testing but used per payer rules if CRNA billed for related services.

Taxonomy Code	Specialty	Notes
`208D00000X`	Internal Medicine	Primary care providers who order screening and follow-up for hepatitis C.
`207Q00000X`	Family Medicine	Commonly orders HCV screening in outpatient and community settings.
`261QP2000X`	Clinical Laboratory	Laboratory providers performing nucleic acid amplification testing and reporting results.
`207L00000X`	Infectious Disease	Specialists involved in confirmatory testing interpretation and treatment initiation for positive HCV RNA results.
`363LA2200X`	Phlebotomy Technician	Personnel performing specimen collection for molecular testing.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z11.3`	Encounter for screening for infections with a predominantly sexual mode of transmission	Common screening encounter code when ordering HCV nucleic acid testing for asymptomatic at-risk patients.
`B18.2`	Chronic viral hepatitis C	Directly indicates established chronic HCV infection; nucleic acid testing is used for diagnosis and monitoring.
`R75`	Inconclusive laboratory evidence of human immunodeficiency virus [HIV]	Often used in patients with other infectious risk factors who are undergoing multiple infectious disease screens including HCV RNA testing.
`Z20.2`	Contact with and (suspected) exposure to infections with a predominantly sexual mode of transmission	Used when documenting known exposure prompting HCV RNA screening.
`Z72.51`	High-risk sexual behavior	Risk-factor code that supports medical necessity for targeted HCV screening with RNA testing.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36415`	Collection of venous blood by venipuncture	Specimen collection commonly performed immediately prior to sending sample for `G0567` testing.
`87811`	Infectious agent detection by nucleic acid (DNA or RNA); multiple-organism, non-culture technique, amplified probe technique, quantitative, each organism	May be used for quantitative or alternate nucleic acid amplification assays for viral load if reflex or confirmatory testing is performed after `G0567` screening.
`87521`	Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, direct probe technique	Alternative molecular HCV detection method; used in labs that perform direct probe rather than amplified probe assays.
`87340`	Hepatitis C antibody, single step method (e.g., enzyme immunoassay)	Serologic screening test that may precede or accompany nucleic acid testing; positive antibody often triggers `G0567` RNA testing for active infection.
`96374`	Therapeutic, prophylactic, or diagnostic injection (intramuscular), each; 1 or more drugs or biologicals	May be billed in the clinical workflow when vaccination or injectable prophylaxis is provided during the same visit (workflow-related service).

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