Human Immunodeficiency Virus (HIV) Screening - JF Part B
Human Immunodeficiency Virus (HIV) Screening
HCPCS/CPT Codes
- 80081 - Obstetric panel (includes HIV testing)
- G0432 - Infectious agent antibody detection by enzyme immunoassay (EIA) technique
- G0433 - Infectious agent antibody detection by enzyme-linked immunosorbent assay (ELISA) technique
- G0435 - Infectious agent antibody detection by rapid antibody test
- G0475 - HIV antigen/antibody, combination assay, screening
Frequency
- Annually for beneficiaries between 15 - 65 years without regard to perceived risk
- Annually for beneficiaries under 15 years and adults older than 65 who are at increased risk for HIV infection:
- Men who have sex with men
- Men and women having unprotected vaginal or anal intercourse
- Past of present injection drug users
- Men and women who exchange sex for money or drugs or have sex partners who do
- Individuals whose past or present sex partners were HIV-infected, bisexual, or injection drug users,
- Persons who have acquired or request testing for other sexually transmitted infectious diseases,
- Persons with a history of blood transfusions between 1978 and 1985,
- Persons who request an HIV test despite reporting no individual risk factors,
- Persons with new sexual partners,
- Persons who, based on individualized physician interview and examination
- Pregnant beneficiaries covered three times during pregnancy
- When diagnosed as pregnant
- During third trimester
- At labor, if ordered by clinician
Diagnosis Code
Increased risk factors not reported
- Z11.4 - Encounter for screening for human immunodeficiency virus
Increased risk factors reported
- Z11.4 - Encounter for screening for human immunodeficiency virus; and
- Z72.89 - Other problems related to lifestyle
- Z72.51 - High risk heterosexual behavior
- Z72.52 - High risk homosexual behavior; or
- Z72.53 - High risk bisexual behavior
Pregnant Medicare beneficiaries
- Z11.4 - Encounter for screening for human immunodeficiency virus; and
- 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 one of the following:
- Beneficiaries at increased risk for HIV infection
- Anyone who asks for test
- Pregnant women
Noncoverage
- Beneficiary with any known diagnosis of HIV-related illness
- Beneficiary who has had screening within one year
- Pregnant beneficiary who has had three specified screening tests within each respective term of pregnancy
Payment
Copayment/coinsurance waived; Deductible waived
Noridian Medicare Portal
Yes - G0475
Resources
Last Updated Mar 20 , 2024