New Service! Medicare began covering HCV screening effective June 2, 2014.
HCPCS/CPT Codes
G0472 – Hepatitis C antibody screening, for individual at high risk and other covered indication(s)
ICD-10-CM (ICD-9-CM) Codes
Report one of the following codes for high risk beneficiaries:
Z72.89 (V69.8) - initial claim;
Z72.89 (V69.8) and F19.20 (304.91) - subsequent claims for high risk beneficiaries with continued illicit injection drug use since prior negative screening
Who Is Covered
Certain adult Medicare beneficiaries who:
Are at high risk for HCV infection; or
Those at high risk because they’ve had a blood transfusion before 1992
Annually only for high risk beneficiaries with continued illicit injection drug use since the prior negative screening test; or
Once for Medicare beneficiaries born from 1945 through 1965 who are not considered high risk (use ICD-10 Z11.59; effective October 1, 2017).
•An initial screening for Medicare beneficiaries, regardless of birth year, for adults at high risk, that is, beneficiaries who had a blood transfusion before 1992 and beneficiaries with a current or past history of illicit injection drug use).