HCPCS codes to report HIV Screening

G0432 – Infectious agent antibody detection by enzyme immunoassay (EIA) technique, HIV-1 and/or HIV-2, screening,

G0433 – Infectious agent antibody detection by enzyme-linked immunosorbent assay (ELISA) technique, HIV-1 and/or HIV-2, screening, and,

G0435 – Infectious agent antibody detection by rapid antibody test, HIV-1 and/or HIV-2, screening.

Diagnosis code

Claims for the annual HIV screening must contain one of the new HCPCS along with a primary diagnosis code of V73.89, and when increased risk factors are reported, a secondary diagnosis code of V69.8.

For pregnant women, one of the new HCPCS codes must be reported with a primary diagnosis code of V73.89 and one secondary diagnosis code of either V22.0 (Supervision of normal first pregnancy), V22.1 (Supervision of other normal pregnancy), or V23.9 (Supervision of unspecified high-risk pregnancy).

Coverage Limitations

1. 11 full months must elapse following the month in which the previous test was performed in order for the subsequent test to be covered.

2. Three voluntary HIV screenings of pregnant Medicare beneficiaries at the following times:

(1) when the diagnosis of pregnancy is known,

(2) during the third trimester, and

(3) at labor, if ordered by the woman’s clinician.

Three tests will be covered for each term of pregnancy beginning with the date of the first test.

3. Patients with any known prior diagnosis of HIV-related illness are not eligible for this screening test.

CDC recommendations

• HIV screening—another term for testing without regard to risk—is recommended for patients ages 13 to 64 in all health care settings after the patient is notified that testing will be performed unless the patient declines (opt-out screening).

• HIV re-testing of people at high risk for HIV infection is recommended at least once a year.

• Consent for screening should be considered to be part of the general consent for medical care, as it is for other non-invasive diagnostic and screening tests. Separate written informed consent for an HIV test is not recommended.

• Prevention counseling should not be required with HIV diagnostic testing or in conjunction with HIV screening programs in health care settings.

For more information: http://www.cms.gov/MLNMattersArticles/downloads/MM6786.pdf

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