Medicare Part B (Medical Insurance) covers HIV (Human Immunodeficiency Virus) screenings. HIV is the virus that can lead to AIDS (Acquired Immunodeficiency Syndrome).

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

HCPCS/CPT Codes

80081 - Obstetric panel (includes HIV testing)

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

G0475 - HIV antigen/antibody, combination assay, screening

ICD-10-CM Codes

Z11.4

Frequency

   • Annually for Medicare beneficiaries between the ages of 15 and 65 without regard to perceived risk

   • Annually for Medicare beneficiaries younger than 15 and adults older than 65 who are at increased risk for HIV infection

   • For Medicare beneficiaries who are pregnant, 3 times per pregnancy:

      • First, when a woman is diagnosed with pregnancy

      • Second, during the third trimester

      • Third, at labor, if ordered by the woman’s clinician

Medicare Beneficiary Pays

   • Copayment waived

   • Coinsurance waived

   • Deductible waived

References