80081 – Obstetric panel (includes HIV testing)

G0432 – Infectious agent antibody detection by enzyme immunoassay (EIA) technique, hiv-1 and/or hiv-2, screening

G0433 – Infectious agent antibody detection by enzyme-linked immunosorbent assay (ELISA) technique, hiv-1 and/or hiv-2, screening

G0435 – Infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, screening

G0475 – HIV antigen/antibody, combination assay, screening

Beneficiaries not reporting increased risk:

• Z11.4

Beneficiaries reporting increased risk:

• Z11.4 and Z72.89 (V69.8), Z72.51, Z72.52, or Z72.53
• Z11.59 (V73.89) – Primary; and
• Z72.89 (V69.8) – Secondary, as appropriate

Pregnant beneficiaries:

• Z11.4 and Z34.00 (V22.0), Z34.01, Z34.02, Z34.03, Z34.80 (V22.1), Z34.81, Z34.82, Z34.83, Z34.90, Z34.91, Z34.92, Z34.93, O09.90 (V23.9), O09.91, O09.92, or O09.93
• Z11.59 (V73.89) – Primary; and
• Z34.00 (V22.0), V22.1 (Z34.80 or Z34.90 (V22.1), or O09.90, O09.92, O09.92, or O09.93 (V23.9) – Secondary, as appropriate

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

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