Medicare announced it will cover certain screenings for hepatitis B virus (HBV) infection, when ordered by the patient’s primary care physician (or practitioner within the context of a primary care setting).
The coverage will be effective for these services performed on or after Sept. 28, 2016:
HCPCS code G0499: Screening for asymptomatic, nonpregnant adolescents and adults at high risk for HBV infection
Medicare covers a single, one-time screening test for these patients. Repeat screening for high-risk patients is covered annually only for those who are a continued high risk and who do not receive hepatitis B vaccination.
CPT codes 86704, 86706, 87340, and 87341: HBV screening for pregnant women
Medicare covers one screening per pregnancy at the first prenatal visit, and one additional screening per pregnancy in women who are at continued risk for HBV infection.
“High risk” is defined as people born in countries and regions with a high prevalence of HBV infection (2 percent or more), U.S.-born people not vaccinated as infants whose parents were born in regions with a very high prevalence of HBV infection (8 percent or more), and HIV-positive persons. Also high risk — and considered to be at continued high risk — are men who have sex with men, injection drug users, and household contacts or sexual partners of persons with HBV infection.
HCPCS code G0499 will be effective retroactive to Sept. 28, 2016. Note, however, that Novitas Solutions, the Medicare payer for Texas, will not search for claims containing HCPCS G0499 with dates of service on or after Sept. 28 but may adjust claims you bring to its attention.
For details about coding and billing Medicare for HBV screening, see the Centers for Medicare & Medicaid Services’ MLN Matters No. MM9859.
Published May 16, 2017
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