`G0452` Molecular pathology interpr

Molecular pathology procedure; physician interpretation and report

Medicare coverage: Carrier judgment
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 6 units per day (clinical), rationale: Clinical: Data
Outpatient hospital: max 1 units per day (clinical), rationale: Nature of Service/Procedure

Medicare pricing for G0452

Physician Fee Schedule (CY 2026, RVU26D)

Status A: active, paid separately under the PFS if covered. Global period XXX. Qualifying APM participants are paid at a $33.5675 conversion factor.

global: national non-facility $46.76, facility $46.76 (total RVUs 1.40 / 1.40 × $33.4009 conversion factor; facility NA: rarely or never done in that setting)
professional component (26): national non-facility $43.76, facility $43.76 (total RVUs 1.31 / 1.31 × $33.4009 conversion factor)
technical component (TC): national non-facility $3.01, facility $3.01 (total RVUs 0.09 / 0.09 × $33.4009 conversion factor; facility NA: rarely or never done in that setting)

Payer policies and prior authorization for G0452

1 of 1 payer prior-auth lists that name G0452 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue).

Payer	Plan	State	Prior auth	Conditions	Since	Source
Blue Cross Blue Shield of Arizona (AZ Blue)	Federal Employee Program (FEP)	AZ	prior auth required		Sep 1, 2026	Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026)

Payer coverage policies that name G0452

G0452 appears in 2 coverage policies from Blue Cross & Blue Shield of Mississippi, Blue Shield of California.

Payer	Policy	Role in policy	Reviewed	Document
Blue Cross & Blue Shield of Mississippi	Genetic Testing (L.2.04.409)	covered if criteria are met		payer document
Blue Shield of California	Genetic Testing for Predisposition to Inherited Hypertrophic Cardiomyopathy (2.02.28)	listed, no stance		payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

CO: $37.99 (chp_plus, non-facility), effective Jul 1, 2026
IN: $38.77 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
LA: $15.94 (lab_radiology), effective Jul 1, 2025
MS: $2.30 (comprehensive), effective Jul 1, 2026
ND: $0.00 (physician), effective Aug 1, 2026
OH: $2.09 (lab), effective Apr 1, 2026
VT: $2.41 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

G0452 Molecular pathology interpr