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Preventive Services: Hepatitis C Virus (HCV) Screening

By:  Find-A-Code
Published:  September 1st, 2017

The following information from the Medicare Learning Network provides guidance from the Department of Health and Human Services on Hepatitis C Virus (HCV) Screening: 

HCPCS/CPT Codes

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

ICD-10 Codes

Z72.89 and F19.20

Who Is Covered

Certain adult Medicare beneficiaries who fall into at least one of the following categories:

  • High risk for HCV infection
  • Born between 1945 and 1965
  • Had a blood transfusion before 1992

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 Medicare beneficiaries with continued illicit injection drug use since the prior negative (HCV) screening test
  • Once for Medicare beneficiaries born between 1945 and 1965 who are not considered high risk
  • An initial screening for Medicare beneficiaries, regardless of birth year, who had a blood transfusion before 1992 and beneficiaries with a current or past history of illicit injection drug use

Medicare Beneficiary Pays

  • Copayment/coinsurance waived
  • Deductible waived

Other Notes


Please note: The information in this educational product applies only to the Medicare Fee-For-Service Program (also known as Original Medicare). For additional guidance on using diagnosis codes, go to the Medicare Claims Processing Manual, Chapter 18 on the Centers for Medicare & Medicaid Services (CMS) website.

Watch the CMS Provider Minute: Preventive Services video for pointers to help you submit sufficient documentation when billing for certain preventive services.


References:

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