How To Use HCPCS Code G0499

HCPCS code G0499 describes a specific screening procedure for Hepatitis B in non-pregnant individuals who are considered to be at high risk. This code includes the testing for Hepatitis B surface antigen (HBsAg), antibodies to HBsAg (anti-HBs), and antibodies to Hepatitis B core antigen (anti-HBc). Additionally, it covers the cost of a neutralizing confirmatory test, if performed, in cases where the initial HBsAg result is reactive. This article will provide a comprehensive understanding of HCPCS code G0499, including its official description, procedure, usage guidelines, billing requirements, historical information, and coverage by Medicare and other insurance providers.

1. What is HCPCS G0499?

HCPCS code G0499 is a specific code used to identify the screening procedure for Hepatitis B in non-pregnant individuals who are considered to be at high risk. It encompasses the testing for HBsAg, anti-HBs, and anti-HBc, as well as a confirmatory test if the initial HBsAg result is reactive. This code is essential for accurate billing and reimbursement purposes.

2. Official Description

The official description of HCPCS code G0499 is “Hepatitis B screening in non-pregnant, high-risk individual includes hepatitis B surface antigen (HBsAg), antibodies to HBsAg (anti-HBs) and antibodies to hepatitis B core antigen (anti-HBc), and is followed by a neutralizing confirmatory test, when performed, only for an initially reactive HBsAg result.” The short description is “Hepb screen high-risk indiv.”

3. Procedure

1. The healthcare provider begins the procedure by collecting a blood sample from the high-risk individual.
2. The collected blood sample is then sent to a laboratory for analysis.
3. In the laboratory, the sample is tested for the presence of HBsAg, anti-HBs, and anti-HBc.
4. If the initial HBsAg result is reactive, a neutralizing confirmatory test is performed to confirm the presence of Hepatitis B.
5. The results of the screening and confirmatory tests are documented and communicated to the healthcare provider.

4. When to use HCPCS code G0499

HCPCS code G0499 should be used when conducting a screening for Hepatitis B in non-pregnant individuals who are considered to be at high risk. These high-risk individuals may include individuals with a history of intravenous drug use, individuals with multiple sexual partners, healthcare workers, and individuals with a history of exposure to Hepatitis B. It is important to ensure that the screening is performed in accordance with the specific eligibility criteria and guidelines set forth by the healthcare provider or insurance company.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0499, healthcare providers need to ensure that the following documentation requirements are met:

• Documentation of the screening procedure performed, including the collection of the blood sample and the laboratory analysis.
• Documentation of the specific tests conducted, such as HBsAg, anti-HBs, and anti-HBc.
• If applicable, documentation of the neutralizing confirmatory test performed for initially reactive HBsAg results.
• Accurate and complete coding of the procedure using HCPCS code G0499.

6. Historical Information and Code Maintenance

HCPCS code G0499 was added to the Healthcare Common Procedure Coding System on September 28, 2016. It has an effective date of April 01, 2018. As of now, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. It is important to stay updated with any changes or revisions to the code in order to ensure accurate billing and reimbursement.

7. Medicare and Insurance Coverage

HCPCS code G0499 is covered by Medicare and other insurance providers. The pricing indicator code for this code is 13, which means that the price is established by carriers based on individual determination and carrier discretion. The multiple pricing indicator code is A, indicating that it is not applicable as HCPCS is priced under one methodology. It is important to verify the coverage and reimbursement policies of specific insurance providers to ensure proper billing and reimbursement.

8. Examples

Here are five examples of when HCPCS code G0499 should be billed:

1. A 45-year-old male with a history of intravenous drug use presents for a routine check-up. The healthcare provider performs a Hepatitis B screening, including the necessary tests, and the results are documented.
2. A 30-year-old female healthcare worker undergoes a pre-employment health screening. As part of the screening, a Hepatitis B screening is performed, and the results are documented.
3. A 50-year-old male with a history of multiple sexual partners visits a healthcare provider for a general health examination. The healthcare provider orders a Hepatitis B screening, including the necessary tests, and the results are documented.
4. A 35-year-old female presents to a healthcare facility with a history of exposure to Hepatitis B. The healthcare provider performs a Hepatitis B screening, including the necessary tests, and the results are documented.
5. A 60-year-old male with a history of intravenous drug use and multiple sexual partners visits a healthcare provider for a routine check-up. The healthcare provider orders a Hepatitis B screening, including the necessary tests, and the results are documented.