Coding/Billing Newly-covered Hepatitis B Screening
Recognizing the U.S. Preventive Services Task Force’s updated recommendations for hepatitis B virus (HBV) screening, Medicare has added Part A and Part B coverage for HBV screening, effective Sept. 28, 2016. Naturally, there are conditions for coverage.
Conditions for Coverage
- The screening must be performed using the appropriate FDA-approved laboratory test, used consistent with FDA-approved labeling and in compliance with the Clinical Laboratory Improvement Act regulations;
- The screening must be ordered by the patient’s primary care physician or practitioner in the primary care setting; and
- The patient must be either an asymptomatic, non-pregnant adolescent/adult at high risk for HBV infection, or pregnant.
Coverage provides for non-pregnant adolescents/adults at high risk for HBV infection to receive one screening annually. Pregnant women should be screened at the first prenatal visit (of each pregnancy) and then rescreened at the time of delivery for those with new or continuing risk factors.
Note: See MLN Matters MM9859 for definitions of “primary care physician or practitioner,” “primary care setting” and “high risk.”
Procedure Coding for HBV Screening
For HBV screening of asymptomatic, non-pregnant adolescents/adults at high risk, use HCPCS Level II code G0499 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); and for HBV screening of pregnant women, use immunology codes 86704, 86706, or microbiology codes 87340, 87341, as appropriate.
Diagnosis Coding for HBV Screening
For non-pregnant adolescents/adults at high risk for HBV infection, CMS will allow coverage for G0499 only when services are reported with both:
Z11.59 Encounter for screening for other viral disease
Z72.89 Other problems related to lifestyle
CMS will allow coverage for G0499 for subsequent visits when reported with Z11.59 and one of the following high-risk codes, as appropriate:
F11.10 – F11.99
F13.10 – F13.99
F14.10 – F14.99
F15.10 – F15.99
For HBV screening in pregnant women report the appropriate CPT code with Z11.59 and one of the following:
Z34.00 Encounter for supervision of normal first pregnancy, unspecified trimester
Z34.80 Encounter for supervision of other normal pregnancy, unspecified trimester
Z34.90 Encounter for supervision of normal pregnancy, unspecified, unspecified trimester
O09.90 Supervision of high risk pregnancy, unspecified, unspecified trimester
For HBV screening in pregnant women at high risk, report the appropriate CPT code with Z11.59, Z72.89, and one of the following ICD-10-CM codes, as appropriate:
Z34.00 – Z34.03
Z34.80 – Z34.83
Z34.90 – Z34.93
O09.90 – O09.93
Billing for HBV Screening
Bring claims containing G0499 with dates of service on or after Sept. 28. 2016, to your Medicare administrative contractor’s (MAC) attention for claims adjustment. Only then will MACs apply contractor pricing to claim lines with G0499 with dates of service Sept. 28, 2016, through Dec. 31, 2017.
Medicare deductible and coinsurance do not apply to G0499.