Billing Requirements for Screening for STIs and HIBC to Prevent STIs (Rev. 2476, 02-27-12)

by  Jared Staheli
July 6th, 2015

Effective for dates of service November 8, 2011, and later, contractors shall recognize HCPCS code G0445 for HIBC. Medicare shall cover up to two occurrences of G0445 when billed for HIBC to prevent STIs. A claim that is submitted with HCPCS code G0445 for HIBC shall be submitted with ICD-9 diagnosis code V69.8.

Medicare contractors shall pay for screening for chlamydia, gonorrhea, and syphilis (As indicated by the presence of ICD-9 diagnosis code V74.5); and/or hepatitis B (as indicated by the presence of ICD-9 diagnosis code V73.89) as follows:

• One annual occurrence of screening for chlamydia, gonorrhea, and syphilis (i.e., 1 per 12-month period) in women at increased risk who are not pregnant,

• One annual occurrence of screening for syphilis (i.e., 1 per 12-month period) in men at increased risk,

• Up to two occurrences per pregnancy of screening for chlamydia and gonorrhea in pregnant women who are at increased risk for STIs and continued increased risk for the second screening,

• One occurrence per pregnancy of screening for syphilis in pregnant women,

• Up to an additional two occurrences per pregnancy of screening for syphilis in pregnant women if the beneficiary is at continued increased risk for STIs,

• One occurrence per pregnancy of screening for hepatitis B in pregnant women, and,

• One additional occurrence per pregnancy of screening for hepatitis B in pregnant women who are at continued increased risk for STIs.

References:

• Pub 100-04 Medicare Claims Processing Manual - Chapter 18