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:
|G0472 -||Hepatitis C antibody screening, for individual at high risk and other covered indication(s)|
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
- 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
- Refer to Screening for Hepatitis C Virus (HCV) in Adults for more information.
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.