Institutional Billing Requirements for Screening for Hepatitis C Virus (HCV) (Rev. 3215, 01-05-15)

by  Jared Staheli
July 7th, 2015

Effective for claims with dates of service on and after June 2, 2014, providers may use the following types of bill (TOBs) when submitting claims for screening for HCV screening, HCPCS G0472: 13X, 71X, 77X, and 85X. Service line-items on other TOBs shall be denied.

The service shall be paid on the basis shown below:

-Outpatient hospitals – TOB 13X - based on Outpatient Prospective Payment System (OPPS)

-Critical Access Hospitals (CAHs) - TOB 85X – based on reasonable cost

-CAH Method II – TOB 85X - based on 115% of the lesser of the Medicare Physician Fee Schedule amount or actual charge as applicable with revenue codes 096X, 097X, or 098X.

NOTE: For RHCs and FQHCs that are authorized to bill under the all-inclusive rate (AIR) system, payment for the professional component is included in the AIR. For FQHCs authorized to bill under the FQHC prospective payment system (PPS), payment for the professional component in included in the FQHC PPS rate. HCV screening is not a stand-alone payable visit for RHCs and FQHCs.

NOTE: For outpatient hospital settings, as in any other setting, services covered under this NCD must be ordered by a primary care provider within the context of a primary care setting and performed by an eligible Medicare provider for these services.

References:

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