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Medicare Coverage for Zika Virus Testing
In February, 2016 the Zika virus was declared a PHE by the WHO. In the United States, the CDC considers the Zika virus disease to be a nationally notifiable condition.
The Zika virus is primarily spread through the bite of an infected Aedes species mosquito, although other modes of transmission (including mother-to-child, blood and sexual transmission) have been documented.
Currently, there are a few diagnostic tests that can determine the presence of the virus, and these are available through the CDC and certain CDC-approved health laboratories. In addition, a small number of tests have been released on an emergency basis to commercial laboratories.
Coverage is available through Medicare Part B for clinical diagnostic laboratory tests that are reasonable and necessary for the diagnosis or treatment of a person’s illness or injury. This means that testing for the Zika virus may be considered medically necessary when a beneficiary’s clinical history and symptoms indicate the possibility of infection with the virus. Coverage for this testing is not available on a screening basis, but only for situations in which there is valid medical reason to suspect Zika infection.
Providers billing for Zika viral testing may submit claims using the following codes:
- CPT Code 87798 (infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism)
- ICD-10 Code A92.9 (through 9/30/2016)
- ICD-10 Code A92.5 (10/1/2016 and thereafter)
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Reviewed 10/11/2023