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Human Immunodeficiency Virus (HIV) Screening (NCD 210.7)

Effective April 13, 2015, procedure code G0475 may be billed for HIV screening.

HCPCS/CPT Codes


80081 – Obstetric panel (includes HIV testing)

G0432 – Infectious agent antibody detection by enzyme immunoassay (EIA) technique, hiv-1 and/or hiv-2, screening

G0433 – Infectious agent antibody detection by enzyme-linked immunosorbent assay (ELISA) technique, hiv-1 and/or hiv-2, screening

G0435 – Infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, screening

G0475 – HIV antigen/antibody, combination assay, screening

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


Beneficiaries not reporting increased risk:

  • Z11.4

Beneficiaries reporting increased risk:

  • Z11.4 and Z72.89 (V69.8), Z72.51, Z72.52, or Z72.53
  • Z11.59 (V73.89) – Primary; and
  • Z72.89 (V69.8) – Secondary, as appropriate

Pregnant beneficiaries:

  • Z11.4 and Z34.00 (V22.0), Z34.01, Z34.02, Z34.03, Z34.80 (V22.1), Z34.81, Z34.82, Z34.83, Z34.90, Z34.91, Z34.92, Z34.93, O09.90 (V23.9), O09.91, O09.92, or O09.93
  • Z11.59 (V73.89) – Primary; and
  • Z34.00 (V22.0), V22.1 (Z34.80 or Z34.90 (V22.1), or O09.90, O09.92, O09.92, or O09.93 (V23.9) – Secondary, as appropriate

Who Is Covered


Certain Medicare beneficiaries who are at increased risk for HIV infection, including anyone who asks for the test, or pregnant women.

NOTE: “Increased risk for HIV infection” is defined in the Medicare National Coverage Determinations Manual, Publication 100-03, Chapter 1, Section 210.7

Frequency


Annually for beneficiaries at increased risk, including anyone who asks for the test

For beneficiaries who are pregnant, 3 times per pregnancy:

  • First, when a woman is diagnosed with pregnancy;
  • Second, during the third trimester; and
  • Third, at labor, if ordered by the woman’s clinician

Beneficiary Pays


  • Copayment/coinsurance waived
  • Deductible waived

Other Notes


References



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