How To Bill HIV Screening | HCPCS G0432, HCPCS G0433 & HCPCS G0435
HIV screening can be done with an enzyme immunoassay (EIA) technique (HCPCS G0432), an enzyme-linked immunosorbent assay (ELISA) technique (HCPCS G0433), or a rapid antibody test (HCPCS G0435).
1. General Billing Guidelines
Medicare covers infectious agent antibody detection by enzyme-linked immunosorbent assay ELISA technique for HIV 1 and HIV 2 screening.
Medicare provides coverage for this HIV screening test once a year for beneficiaries with an increased risk of infection.
Medicare also covers HIV screening in pregnancy up to three times if the woman’s clinician requests the HIV screening for the mother and the unborn child.
2. What Is HIV And How Is It Detected?
When the human immunodeficiency virus infects the body, the body produces special proteins called antibodies to fight against the virus.
Enzyme-linked immunosorbent assay detects these special proteins, typically using a biochemical color change to identify the antibodies present.
Following a positive screening test, the provider must perform confirmatory tests to rule out HIV infection.
3. What Is HCPCS Code G0432?
Use G0432 when the provider screens a patient for the presence of the human immunodeficiency virus, HIV 1 or HIV 2 virus antibody using an enzyme immunoassay technique or EIA.
3.1 Description
HCPCS officially describes G0432 as: “Infectious agent antibody detection by enzyme immunoassay (EIA) technique, HIV-1 and/or HIV-2, screening.”
3.2 Procedure
HCPCS code G0432 code represents an enzyme immunoassay screening technique that a provider performs to identify the presence of HIV 1 or HIV 2 virus antibodies.
The provider collects a sample of the patient’s body fluid, mainly an oral fluid sample, for the enzyme immunoassay test.
4. What Is HCPCS Code G0433?
Use G0433 when the provider screens a patient for the presence of the human immunodeficiency virus, or HIV 1 or HIV 2 virus antibody using an enzyme-linked immunosorbent assay technique or ELISA.
4.1 Description
The official description of HCPCS code G0433 is as follows:“Infectious agent antibody detection by enzyme-linked immunosorbent assay (ELISA) technique, HIV-1 and/or HIV-2, screening.”
4.2 Procedure
HCPCS code G0433 represents an immunosorbent assay screening technique to identify the presence of HIV 1 or HIV 2 virus antibodies. The provider collects a sample of body fluid, mainly a blood sample, for this immunosorbent assay test.
5. What Is HCPCS Code G0435?
G0435 can be used when the provider screens a patient for the presence of the human immunodeficiency virus, or HIV 1 or HIV 2 virus antibody using a rapid antibody test.
5.1 Description
G0435 is an HCPCS code, and the official description is: “Infectious agent antibody detection by rapid antibody test, HIV-1 and/or HIV-2, screening.”
5.2 Procedure
The G0435 HCPCS code represents a rapid antibody test technique to identify the presence of HIV 1 or HIV 2 virus antibodies.
The provider collects a sample of body fluid, mainly a blood sample or oral fluid, for this rapid screening test. A rapid test produces results in 20 minutes.
6. References
Buck’s 2022 HCPCS Level II E-Book
https://www.ama-assn.org/system/files/routine-screening-medicare-coding-guide.pdf
https://www.aapc.com/codes/hcpcs-codes/G0433
