Changes to Medicare Coverage of Hepatitis B
Screening: What Physicians Should Know
Date of Publication May 23, 2017
Medicare now covers
screening for Hepatitis B Virus (HBV) infection, effective for services on or after Sept. 28, 2016. Practices should be aware that Medicare coinsurance and the Part B deductible are waived for this preventive service.
Medicare will cover screening for HBV infection, when ordered by the beneficiary's primary care physician or practitioner within the context of a primary care setting, and performed by an eligible Medicare provider for these services, within the context of a primary care setting if the screening is:
- Performed with the appropriate U.S. Food and Drug Administration (FDA) approved/cleared laboratory tests.
- Used consistent with FDA-approved labeling.
- In compliance with the Clinical Laboratory Improvement Act (CLIA) regulations.
HBV screening is approved for beneficiaries who meet the following conditions:
- Asymptomatic, non-pregnant adolescents and adults at high risk for HBV infection.
- Pregnant women at the first prenatal visit and then rescreening at time of delivery for those with new or continuing risk factors.
Coding for Hepatitis B Screening
Claims processing instructions for payment of Hepatitis B Virus screening apply to the following HCPCS and CPT codes:
- Code G0499 – HBV screening for asymptomatic, non-pregnant adolescents and adults at high risk
- CPT codes 86704, 86706, 87340, and 87341 – HBV screening for pregnant women
For detailed information on which beneficiaries meet the conditions for HBV testing, as well as billing and reporting requirements, check out CMS' MLN Matters article on HBV Screening here.