Sexually Transmitted Infections (STIs) Screening and High Intensity Behavioral Counseling (HIBC) to Prevent STIs - JF Part A
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
- 0455U - Combined chlamydia and gonorrhea testing (replaced 0353U ended July 1, 2024)
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
Last Updated Dec 27 , 2024
