Human Immunodeficiency Virus (HIV) Screening
HCPCS/CPT Codes
G0432 – Infectious agent antibody detection by enzyme immunoassay (EIA) technique
G0433 – Infectious agent antibody detection by enzyme-linked immunosorbent assay (ELISA) technique
G0435 – Infectious agent antibody detection by rapid antibody test
ICD-10-CM Codes
High risk – Z11.4 and Z72.89
Not high risk – Z11.4
Pregnant beneficiaries – Z11.4 and Z34.00, Z34.01, Z34.02, Z34.03, Z34.80, Z34.81, Z34.82, Z34.83, Z34.90, Z34.91, Z34.92, Z34.93, O09.90, O09.91, O09.92, OR O09.93
Who Is Covered
Certain Medicare beneficiaries who are at increased risk for HIV infection, including anyone who asks for the test, or pregnant women
NOTE: “Increased risk for HIV infection” is defined in the Medicare National Coverage Determinations Manual, Publication 100-03, Chapter 1, Section 210.7.
Frequency
Annually for beneficiaries at increased risk, including anyone who asks for the test For beneficiaries who are pregnant, 3 times per pregnancy:
• First, when a woman is diagnosed with pregnancy;
• Second, during the third trimester; and
• Third, at labor, if ordered by the woman’s clinician
Beneficiary Pays
• Copayment/coinsurance waived
• Deductible waived
HIV – Human Immunodeficiency
Virus – Screening for Adolescents and Adults (Males and Females)
Procedure Code(s): 86689, 86701, 86702, 86703, G0432, G0433, G0435, G0475, S3645, 36415, 36416
Diagnosis Code(s):
• ICD-9: V02.9, V70.0, V73.89, V74.5, V75.9,
• ICD-10: Z00.00, Z00.01, Z22.6, Z22.8, Z22.9, Z11.3, Z11.4, Z11.59, Z11.9, Z20.6
OR Pregnancy (see list at end of section).
Adolescents and adults, including pregnant women.
