Hepatitis C Virus (HCV) Screening

HCPCS/CPT Codes

G0472 - Hepatitis C antibody screening, for individual at high risk and other covered indication(s)

Frequency

  • Annually only for high risk beneficiaries with continued illicit injection drug use since prior negative screening test
  • Once in a lifetime for beneficiaries born between 1945 and 1965 who are not considered high risk
  • Initial screening, regardless of birth year, who had a blood transfusion before 1992 and beneficiaries with current or past history of illicit injection drug use

Diagnosis Code

Initially high-risk

  • Z72.89 - Other problems related to lifestyle

High risk with continued illicit injection drug use since prior screening

  • Z72.89 - Other problems related to lifestyle; and
  • F19.20 - Other psychoactive substance dependence, uncomplicated

Coverage

  • Ordered by primary care physician or practitioner; and
  • Beneficiary must be either be:
    • High risk for HCV infection
      • Persons with current or past history of illicit injection drug use
      • History of receiving blood transfusion prior to 1992
    • Born between 1945 and 1965

Payment

Copayment/coinsurance waived; Deductible waived

Noridian Medicare Portal

Yes - G0472

Resources

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