Back to Preventive Services Home Page

Hepatitis C Virus (HCV) Screening (NCD 210.13)

New Service! Medicare began covering HCV screening effective June 2, 2014.

HCPCS/CPT Codes


G0472 – Hepatitis C antibody screening, for individual at high risk and other covered indication(s)

ICD-10-CM (ICD-9-CM) Codes


Report one of the following codes for high risk beneficiaries:

  • Z72.89 (V69.8) - initial claim;
  • Z72.89 (V69.8) and F19.20 (304.91) - subsequent claims for high risk beneficiaries with continued illicit injection drug use since prior negative screening

Who Is Covered


Certain adult Medicare beneficiaries who:

  • Are at high risk for HCV infection; or
  • Those at high risk because they’ve had a blood transfusion before 1992
  • Were born between 1945 and 1965

NOTE: Intermediate and high risk is defined in the Medicare National Coverage Determinations Manual, Chapter 1, Part 4, Section 210.13 – Screening for Hepatitis C Virus (HCV) in Adults.

Frequency


  • Annually only for high risk beneficiaries with continued illicit injection drug use since the prior negative screening test; or
  • Once for Medicare beneficiaries born from 1945 through 1965 who are not considered high risk (use ICD-10 Z11.59; effective October 1, 2017).
  • •An initial screening for Medicare beneficiaries, regardless of birth year, for adults at high risk, that is, beneficiaries who had a blood transfusion before 1992 and beneficiaries with a current or past history of illicit injection drug use).

Beneficiary Pays


  • Copayment/coinsurance waived
  • Deductible waived

Other Notes



Back to Preventive Services Home Page