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Preventive Services: Screening for STIs and High Intensity Behavioral Counseling (HIBC) to Prevent STIs

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 Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) to Prevent STIs: 

HCPCS/CPT Codes

86631 - Antibody; Chlamydia
86632 - Antibody; Chlamydia, IgM
87110 Culture, chlamydia, any source
87270 - Infectious agent antigen detection by immunofluorescent technique; Chlamydia trachomatis
87320 - Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Chlamydia trachomatis
87490 - Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, direct probe technique
87491 - Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique 
87810 - Infectious agent antigen detection by immunoassay with direct optical observation; Chlamydia trachomatis
87590 - Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, direct probe technique
87591 - Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique
87850 - Infectious agent antigen detection by immunoassay with direct optical observation; Neisseria gonorrhoeae
87800 - Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; direct probe(s) technique
86592 -  Syphilis test, non-treponemal antibody; qualitative (e.g., VDRL, RPR, ART)
86593 - Syphilis test, non-treponemal antibody, quantitative
86780 -  Antibody; Treponema pallidum
87340 - Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg)
87341 - Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg) neutralization
G0445 - High intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes 

ICD-10 Codes

Z11.3, Z72.89, Z72.51, Z72.52, Z72.53, 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, and O09.93

Who Is Covered

Certain Medicare beneficiaries when all of the following are true:

  • Sexually active adolescents and adults at increased risk for STIs
  • Referred for this service by a primary care provider and provided by a Medicare-eligible primary care provider in a primary care setting

Frequency

  • One annual occurrence of screening for chlamydia, gonorrhea, and syphilis in women at increased risk who are not pregnant
  • One annual occurrence of screening for syphilis in men at increased risk
  • Up to two occurrences per pregnancy of screening for chlamydia and gonorrhea in pregnant women who are at increased risk for STIs and continued increased risk for the second screening
  • One occurrence per pregnancy of screening for syphilis in pregnant women
    • Up to two additional occurrences in the third trimester and at delivery if at continued increased risk for STIs
  • One occurrence per pregnancy of screening for hepatitis B in pregnant women
    • One additional occurrence at delivery if at continued increased risk for STIs
  • Up to two 30 minute, face-to-face HIBC sessions annually

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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