Wiki G0472- Hep C Screening for Medicare

[insuranceisreallyfun]

I'm helping a fellow coder who has been receiving denials for G0472. Humana Medicare has been paying but Medicare has been denying AM130 and CAS-50. She has verified age appropriate (51-71) and the Hep C screening has not been done before. She is using dx Z72.89 exclusively since this is the screening. I didn't see any LCD/NCD or any NCCI edits that would apply except the 86803 (which isn't being billed). I have also checked Medicare preventative services under a few of my patients and G0472 isn't even on the list for the preventative. Any help or suggestions would be appreciated!
Thanks.

 

[CodingKing]

Here is what I found upon a quick google search:

https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/Downloads/mm8871.pdf

https://www.aapc.com/blog/29963-coverage-update-for-hepatitis-c-virus-screening/

1) Adults at high risk for HCV infection. “High risk” is defined as persons with a current orpast history of illicit injection drug use, and persons who have a history of receiving ablood transfusion prior to 1992. Repeat screening for high risk persons is covered annuallyonly for persons who have had continued illicit injection drug use since the prior negativescreening test.

2) Adults who do not meet the high risk definition as defined above, but who were bornfrom 1945 through 1965. A single, once-in-a-lifetime screening test is covered forthese individuals.

 

[insuranceisreallyfun]

Followibg those guidelines

She is followibg all rhose guidelines and is still receiving denials.