Billing Guidelines For Medicare Screening For Chlamydia and Gonorrhea, Syphilis & Hepatitis B

Billing Guidelines For Screening For chlamydia And Gonorrhea

Pregnant women who are 24 years old or younger when the diagnosis of pregnancy is known and then repeat screening during the third trimester if high-risk sexual behavior has occurred since the initial screening test.

Pregnant women who are at increased risk for STIs when the diagnosis of pregnancy is known and then repeat screening during the third trimester if high-risk sexual behavior has occurred since the initial screening test.

Women at increased risk for STIs annually.

Billing Guidelines For Screening For Syphilis

Pregnant women when the diagnosis of pregnancy is known and then repeat screening during the third trimester and at delivery if high-risk sexual behavior has occurred since the previous screening test.

Men and women at increased risk for STIs annually.

Billing Guidelines For Screening For Hepatitis B

Pregnant women at the first prenatal visit when the diagnosis of pregnancy is known and then re-screening at the time of delivery for those with new or continuing risk factors.

Covered CPT Codes

CMS will cover screening for Chlamydia (CPT 86631, CPT 86632, CPT 87110, CPT 87270, CPT 87320, CPT 87490, CPT 87491, CPT 87810, CPT 87800 (used for combined Chlamydia and gonorrhea testing).

CMS will cover for screening gonorrhea (CPT 87590, CPT 87591, CPT 87850, CPT 87800 (used for combined Chlamydia and gonorrhea testing).

CMS will cover for syphilis (CPT 86592, CPT 86593, CPT 86780)

CMS will cover for hepatitis B (hepatitis B surface antigen) CPT 87340, CPT 87341.

Screening will only be reimbursed with the appropriate FDA approved/cleared laboratory tests, used consistent with FDA-approved labelling and in compliance with the CLIA regulations, when ordered by the primary care provider, and performed by an eligible Medicare provider for these services.

Reference: https://www.cms.gov/MLNMattersArticles/downloads/MM7610.pdf