Part B Insider (Multispecialty) Coding Alert
Learn HIV Risk Factors
PDF
Question: I understand that Medicare has an expanded HIV screening policy for patients in a high risk group. What factors make a patient "high risk" under Medicare's rule? Answer:
Men who have had sex with men after 1975
Men and women having unprotected sex with multiple [more than one] partners
Past or present injection drug users
Men and women who exchange sex for money or drugs,or have sex partners who do
Individuals whose past or present sex partners were HIVinfected, bisexual, or injection drug users
Persons being treated for sexually transmitted diseases
Persons with a history of blood transfusion between 1978 and 1985
Persons who request an HIV test despite reporting no individual risk factors, since this group is likely to include individuals not willing to disclose high-risk behaviors.
Note that Medicare's expanded HIV screening coverage also extends to pregnant women at the following three times:
when the diagnosis of pregnancy is known
during the third trimester
at labor.
Source:
CMS's Decision Memo on HIV screening, available at http://www.cms.gov/transmittals/downloads/R1935CP.pdf.Part B Insider (Multispecialty) Coding Alert
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