Collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (snf) or by a laboratory on behalf of a home health agency (hha)
Medicare coverage: Carrier judgment
Status: active (October 2026 file)
Medically Unlikely Edits (effective October 1, 2026)
Practitioner: max 2 units per day (clinical), rationale: Clinical: Data
Outpatient hospital: max 2 units per day (clinical), rationale: Clinical: Data
Medicare pricing for G0471
Physician Fee Schedule (CY 2026, RVU26D)
Status X: statutory exclusion, not paid under the PFS.
Payer policies and prior authorization for G0471
Medicaid fee-for-service
IN: $9.43 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026
KY: $11.34 (lab), effective Jan 1, 2026
ND: $11.34 (physician), effective Aug 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 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.