Preventive Services

Preventive Services Guide


Hepatitis B Virus Screening

Hepatitis B is a virus that can damage the liver, it is spread through contact with infected blood or body fluids and can be transmitted through sex with an infected person or by sharing injection drug equipment.

Table of Contents

[Return to Top]

Coverage Criteria

Effective for services on or after 9/28/2016, benefits are available for Medicare beneficiaries that fall into any of the following categories:

  • Asymptomatic, nonpregnant adolescents and adults at high risk for HBV
  • Pregnant woman
  • Doctors order is required

[Return to Top]

Frequency

  • Covered annually only for those with continued risk who do not receive the hepatitis B vaccination
  • One screening for asymptomatic, nonpregnant adolescents and adults who do not meet the high risk definition
  • One screening for pregnant women at the first prenatal visit for each pregnancy
    • Rescreening at the time of delivery for those with new or continued risk factors
    • Screening for the first prenatal visit in subsequent pregnancies, regardless of previous HBV vaccination or previous negative hepatitis B surface antigen (HBsAg) results is also covered

[Return to Top]

High-Risk Factors

The determination of high risk for HBV is identified by the primary care physician who assesses the beneficiary’s history as obtained via the annual wellness visit and considered in developing a comprehensive prevention plan. The medical record should include reflection of the service provided.

  • Persons born in countries and regions with a high prevalence of HBV infection
  • U.S.-born persons not vaccinated as infants whose parents were born in countries and regions with a high prevalence
  • HIV positive persons
  • Homosexual men
  • Injection drug users
  • Persons who live in the same household as an HBV carrier
  • Sexual partners of persons with HBV infection

In addition, CMS has determined that repeated screening would be appropriate annually only for beneficiaries with continued high risk (i.e., men who have sex with men, injection drug users, household contacts or sexual partners of persons with HBV infection) who do not receive hepatitis B vaccination.

[Return to Top]

HCPCS/CPT Coding

  • G0499: HBV screening for asymptomatic, nonpregnant adolescents and adults at high risk
  • 86704: Hepatitis B core antibody (HBcAb); total
  • 86706: Hepatitis B surface antibody (HBsAb)
  • 87340: Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg)
  • 87341: Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg), neutralization

[Return to Top]

ICD-10 Diagnosis Coding

For Persons with ESRD

  • Z11.59 and N18.6

For Asymptomatic, Nonpregnant Adolescents and Adults at High Risk

  • Z11.59 and Z72.89

For Asymptomatic, Nonpregnant Adolescents and Adults, Subsequent Visits

For Pregnant Women

  • Z11.59 and one of these: Z34.00, Z34.01, Z34.02, Z34.03, Z34.80, Z34.81, Z34.82, Z34.83, Z34.90, Z34.91, Z34.92, Z34.93

For Pregnant Women at High Risk

  • Z11.59 and Z72.89 and one of the following: O09.90, O09.91, O09.92, O09.93

Additional ICD-10 codes may apply. See the CMS ICD-10 webpage for individual CRs and the specific ICD-10-CM codes Medicare covers for this service, and contact your MAC for guidance.

[Return to Top]

Who Can Perform?

  • 01 – General practice
  • 08 – Family practice
  • 11 – Internal medicine
  • 16 – Obstetrics/gynecology
  • 37 – Pediatric medicine
  • 38 – Geriatric medicine
  • 42 – Certified nurse midwife
  • 50 – Nurse practitioner
  • 89 – Certified clinical nurse specialist
  • 97 – Physician assistant

[Return to Top]

Place of Service (POS) Codes

  • 11 – Physician’s office
  • 19 – Off campus outpatient hospital
  • 22 – On-campus outpatient hospital
  • 49 – Independent clinic
  • 71 – State or local public health clinic
  • 81 – Independent laboratory

Claims submitted without of the POS codes noted above will be denied.

[Return to Top]

Cost Sharing

  • Copayment/coinsurance waived
  • Deductible waived

[Return to Top]

Reimbursement

[Return to Top]

Nonparticipating Providers

  • Nonparticipating reduction applies
  • Limiting charge provision applies

[Return to Top]

Common Claim Denial Reasons

  • Benefit maximum for this time period or occurrence has been reached

[Return to Top]

Related Content

Revised 9/27/2024