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

HCPCS/CPT Codes

  • 86631, 86632, 87110, 87270, 87320, 87490, 87491, 87810 - Chlamydia
  • 87590, 87591, 87850 - Neisseria gonorrhoeae
  • 87800 - Infectious agent detection by nucleic acid, multiple organisms; direct probe(s) technique
  • 86592 - Syphilis test, non-treponemal antibody; qualitative
  • 86593 - Syphilis test, non-treponemal, quantitative
  • 86780 - Treponema pallidum
  • 87340, 87341 - Hepatitis B (hepatitis B surface antigen)
  • G0445 - Semiannual high intensity behavioral counseling to prevent STIs, individual, face-to-face, includes education skills training and guidance on how to change sexual behavior, 30 minutes

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 20-30 minute, face-to-face HIBC sessions annually

Diagnosis Code

  • Z11.3 - Encounter for screening for infections with a predominantly sexual mode of transmission
  • Z72.51 - High risk heterosexual behavior
  • Z72.52 - High risk homosexual behavior
  • Z72.53 - High risk bisexual behavior
  • Z72.89 - Other problems related to lifestyle
  • Z34.00 - Encounter for supervision of normal first pregnancy, unspecified trimester
  • Z34.01 - Encounter for supervision of normal first pregnancy, first trimester
  • Z34.02 - Encounter for supervision of normal first pregnancy, second trimester
  • Z34.03 - Encounter for supervision of normal first pregnancy, third trimester
  • Z34.80 - Encounter for supervision of other normal pregnancy, unspecified trimester
  • Z34.81 - Encounter for supervision of other normal pregnancy, first trimester
  • Z34.82 - Encounter for supervision of other normal pregnancy, second trimester
  • Z34.83 - Encounter for supervision of other normal pregnancy, third trimester
  • Z34.90 - Encounter for supervision of normal pregnancy, unspecified, unspecified trimester
  • Z34.91 - Encounter for supervision of normal pregnancy, unspecified, first trimester
  • Z34.92 - Encounter for supervision of normal pregnancy, unspecified, second trimester
  • Z34.93 - Encounter for supervision of normal pregnancy, unspecified, third trimester
  • O09.90 - Supervision of high risk pregnancy, unspecified, unspecified trimester
  • O09.91 - Supervision of high risk pregnancy, unspecified, first trimester
  • O09.92 - Supervision of high risk pregnancy, unspecified, second trimester; or
  • O09.93 - Supervision of high risk pregnancy, unspecified, third trimester

Coverage

Beneficiaries must meet all of the following criteria:

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

Payment

Copayment/coinsurance waived; Deductible waived

Noridian Medicare Portal

No

Resources

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