Hepatitis C Virus (HCV) Screening - JE Part B

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

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 210
• CMS Medicare Learning Network (MLN) Matters (MM) 8871
• CMS Medicare Preventive Services
• CMS National Coverage Determination (NCD) 210.13