(2022) How To Bill Hepatitis B – CPT Codes & ICD 10 – Descriptions & Guidelines
Hepatitis B screening can be billed with the following codes. CPT 86704, CPT 86706, CPT 87340, CPT 87341 & CPT G0499. The ICD 10 codes for Hepatitis B and the CPT codes can be found below.
CPT Codes For Hepatitis B Screening
The descriptions of the CPT codes for hepatitis B screening are written down below.
86704 CPT Code Description: Hepatitis B core antibody (HBcAb); total
86706 CPT Code Description: Hepatitis B surface antibody (HBsAb)
87340 CPT Code Description: Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg).
87341 CPT Code Description: Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg) neutralization.
G0499 CPT Code Description: Hepatitis b screening in non-pregnant, high risk individual includes hepatitis b surface antigen (HBSAG) followed by a neutralizing confirmatory test for initially reactive results, and antibodies to HBSAG (anti-HBs) and Hepatitis B core antigen(anti-HBc).
ICD 10 Codes For Hepatitis B Screening
ICD 10 B16 – Acute hepatitis B
ICD 10 B16.0 – Acute hepatitis B with delta-agent with hepatic coma
ICD 10 B16.1 – Acute hepatitis B with delta-agent without hepatic coma
ICD 10 B16.2 – Acute hepatitis B without delta-agent with hepatic coma
ICD 10 B16.9 – Acute hepatitis B without delta-agent and without hepatic coma
ICD 10 B17 – Other acute viral hepatitis
ICD 10 B17.0 – Acute delta-(super) infection of hepatitis B carrier
ICD 10 B18 – Chronic viral hepatitis
ICD 10 B18.0 – Chronic viral hepatitis B with delta-agent
ICD 10 B18.1 – Chronic viral hepatitis B without delta-agent
ICD 10 B19 – Unspecified viral hepatitis
ICD 10 B19 – Unspecified viral hepatitis
Billing Guidelines For Hepatitis B Screening
The patient’s primary care physician or practitioner, an eligible Medicare provider, must order the screening within the context of a primary care setting.
The screening must be performed by appropriate U.S. Food and Drug Administration (FDA) approved/cleared laboratory tests, used consistent with FDA approved labeling and in compliance with the Clinical Laboratory Improvement Act (CLIA) regulations.
Patients must be either be:
- Pregnant – A screening test at the first prenatal visit is covered and then re-screening at time of delivery for those with new or continuing risk factors.
- Screening for each pregnancy, regardless of previous hepatitis B vaccination or previous negative HBsAg test results
- Asymptomatic, nonpregnant adolescent/adult at high risk for HBV infection.
- Coverage provides one screening annually.
Place Of Service Codes For Hepatitis B Screening
For claims with dates of service on or after September 28, 2016, CMS will allow coverage for HBV screening only when submitted with one of the following Place of Service (POS) codes.
POS 11 – Physician’s Office
POS 19 – Off Campus Outpatient Hospital
POS 22 – On Campus Outpatient Hospital
POS 49 – Independent Clinic
POS 71 – State or Local Public Health Clinic
POS 81 – Independent Laboratory
Claims submitted without one of the POS codes noted above will be denied.
For claims with dates of service on or after September 28, 2016, CMS will allow coverage for HBV screening only when services are submitted by the following provider specialties found on the provider’s enrolment record.
POS 01 – General Practice
POS 08 – Family Practice
POS 11 – Internal Medicine
POS 16 – Obstetrics/Gynecology
POS 37 – Pediatric Medicine
POS 38 – Geriatric Medicine
POS 42 – Certified Nurse Midwife
POS 50 – Nurse Practitioner
POS 89 – Certified Clinical Nurse Specialist
POS 97 – Physician Assistant
Claims submitted by providers other than the specialty types noted above will be denied.
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