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Preventive Services: Human Immunodeficiency Virus (HIV) 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 Human Immunodeficiency Virus (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 Codes

Increased risk factors not reported - Z11.4

Increased risk factors reported - Z11.4 and Z72.89, Z72.51, Z72.52, or Z72.53

Pregnant Medicare beneficiaries - Z11.4 and Z34.00, Z34.01, Z34.02, Z34.03, Z34.80, Z34.81, Z34.82, Z34.83, Z34.90, Z34.91, Z34.92, Z34.93, O09.90, O09.91, O09.92, or O09.93

Who Is Covered

Certain Medicare beneficiaries without regard to perceived risk or 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, Chapter 1, Part 4, Section 210.7

Frequency

  • Annually for Medicare beneficiaries between the ages of 15 and 65 without regard to perceived risk
  • Annually for Medicare beneficiaries younger than 15 and adults older than 65 who are at increased risk for HIV infection
  • For Medicare beneficiaries who are pregnant, 3 times per pregnancy
    • First, when a woman is diagnosed with pregnancy
    • Second, during the third trimester
    • Third, at labor, if ordered by the woman’s clinician

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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