Billing Requirements for HIV Screening Tests (Rev. 2199, 07-06-10)

by  Jared Staheli
July 6th, 2015

Effective for dates of service December 8, 2009, and later, contractors shall recognize the above HCPCS codes for HIV screening.

Medicare contractors shall pay for voluntary HIV screening as follows in accordance with Pub. 100-03, Medicare National Coverage Determinations Manual, sections 190.14 and 210.7:

• A maximum of once annually for beneficiaries at increased risk for HIV infection (11 full months must elapse following the month the previous test was performed in order for the subsequent test to be covered), and,

• A maximum of three times per term of pregnancy for pregnant Medicare beneficiaries beginning with the date of the first test when ordered by the woman’s clinician.

Claims that are submitted for HIV screening shall be submitted in the following manner: For beneficiaries reporting increased risk factors, claims shall contain HCPCS code G0432, G0433, or G0435 with diagnosis code V73.89 (Special screening for other specified viral disease) as primary, and V69.8 (Other problems related to lifestyle), as secondary.

For beneficiaries not reporting increased risk factors, claims shall contain HCPCS code G0432, G0433, or G0435 with diagnosis code V73.89 only.

For pregnant Medicare beneficiaries, claims shall contain HCPCS code G0432, G0433, or G0435 with diagnosis code V73.89 as primary, and one of the following ICD-9 diagnosis codes: V22.0 (Supervision of normal first pregnancy), V22.1 (Supervision of other normal pregnancy), or V23.9 (Supervision of unspecified high-risk pregnancy), as secondary.

References:

Billing Requirements for HIV Screening Tests (Rev. 2199, 07-06-10). (2015, July 6). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/billing-requirements-for-hiv-screening-tests-rev-2199-07-06-10-27035.html

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