Preventive Services: Human Immunodeficiency Virus (HIV) Screening

by  Find-A-Code
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: 


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


  • 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.


Preventive Services: Human Immunodeficiency Virus (HIV) Screening. (2017, September 1). Find-A-Code Articles. Retrieved from

© InnoviHealth Systems Inc

Article Tags  (click on a tag to see related articles)

Publish this Article on your Website, Blog or Newsletter

This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. If you would like to publish this article, please contact us and let us know where you will be publishing it. The easiest way to get the text of the article is to highlight and copy. Or use your browser's "View Source" option to capture the HTML formatted code.

If you would like a specific article written on a medical coding and billing topic, please Contact Us.


innoviHealth Systems, Inc.
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (8-5 Mountain)
free demo
request yours today
free subscription
for any budget

Thank you for choosing Find-A-Code, please Sign In to remove ads.