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
