Hepatitis C Virus (HCV) Screening

HCPCS/CPT Codes

• G0472 – Hepatitis C antibody screening, for individual at high risk and other covered indication(s)

Covered ICD-10 Codes

The specified below ICD codes are covered for CPT G0472 and may not be limited and some private payers have own specific guidelines,

• B17.10 Acute hepatitis C without hepatic coma
• B17.11 Acute hepatitis C with hepatic coma
• B18.2 Chronic viral hepatitis C
• B18.8 Other chronic viral hepatitis
• B18.9 Chronic viral hepatitis, unspecified
• B19.20 Unspecified viral hepatitis C without hepatic coma
• B19.21 Unspecified viral hepatitis C with hepatic coma
• B19.9 Unspecified viral hepatitis without hepatic coma
• B25.1 Cytomegaloviral hepatitis
• F19.20 Other psychoactive substance dependence, uncomplicated
• O98.411 Viral hepatitis complicating pregnancy, first trimester
• O98.412 Viral hepatitis complicating pregnancy, second trimester
• O98.413 Viral hepatitis complicating pregnancy, third trimester
• O98.419 Viral hepatitis complicating pregnancy, unspecified trimester
• O98.42 Viral hepatitis complicating childbirth
• O98.43 Viral hepatitis complicating the puerperium
• Z72.51 High risk heterosexual behavior
• Z72.52 High risk homosexual behavior
• Z72.53 High risk bisexual behavior
• Z72.89 Other problems related to lifestyle

Who Is Covered

Certain adult Medicare beneficiaries who fall into at least one of the following categories,

• High risk for HCV infection
• Born between 1945 and 1965

Frequency

• Annually only for high risk Medicare beneficiaries with continued illicit injection drug use since the prior negative screening test
• Once in a lifetime for Medicare beneficiaries born between 1945 and 1965 who are not considered high risk

Medicare Beneficiary Pays

• Co-payment/coinsurance waived
• Deductible waived