- Preventive Services Guide
- Medicare Preventive Services Resource Guide
- Alcohol Misuse and Counseling
- Annual Wellness Visit Screening
- Bone Mass Measurements
- Cardiovascular Disease Screening Tests
- Colorectal Cancer Screening
- Counseling to Prevent Tobacco Use
- Depression Screening
- Diabetes Screening
- Diabetes Self-Management Training
- Glaucoma Screening
- Hepatitis B Virus Screening
- Hepatitis B Virus Vaccine and Administration
- Hepatitis C Virus Screening
- Human Immunodeficiency Virus Screening
- Influenza Virus Vaccine and Administration
- Initial Preventive Physical Examination
- Intensive Behavioral Therapy for Cardiovascular Disease
- Intensive Behavioral Therapy for Obesity
- Lung Cancer Screening Counseling and Annual Screening for Lung Cancer with Low-Dose Computed Tomography
- Medical Nutrition Therapy
- Pneumococcal Vaccine and Administration
- Prolonged Preventive Services
- Prostate Cancer Screening
- Screening for Cervical Cancer with Human Papillomavirus Tests
- Screening for Sexually Transmitted Infections and HIBC to Prevent STIs
- Screening Mammography
- Screening Pap Tests
- Screening Pelvic Examinations
- Ultrasound Screening for Abdominal Aortic Aneurysm
- Vaccinations
- Related Articles
- Medicare Preventive Services Resource Guide
- The Annual Wellness Visit
- Medicare’s Annual Wellness Visit in Illinois: Understanding the Benefit and Preventing Denials
- Medicare’s Annual Wellness Visit in Minnesota: Understanding the Benefit and Preventing Denials
- Medicare’s Annual Wellness Visit in Wisconsin: Understanding the Benefit and Preventing Denials
Preventive Services Guide
Hepatitis B Virus Screening
Hepatitis B is a virus that can damage the liver, it is spread through contact with infected blood or body fluids and can be transmitted through sex with an infected person or by sharing injection drug equipment.
Table of Contents
- Coverage Criteria
- Frequency
- High-Risk Factors
- HCPCS/CPT Coding
- ICD-10 Diagnosis Coding
- Who Can Perform?
- Place of Service
- Cost Sharing
- Reimbursement
- Common Claim Denial Reasons
- Related Content
Coverage Criteria
Effective for services on or after 9/28/2016, benefits are available for Medicare beneficiaries that fall into any of the following categories:
- Asymptomatic, nonpregnant adolescents and adults at high risk for HBV
- Pregnant woman
- Doctors order is required
Frequency
- Covered annually only for those with continued risk who do not receive the hepatitis B vaccination
- One screening for asymptomatic, nonpregnant adolescents and adults who do not meet the high risk definition
- One screening for pregnant women at the first prenatal visit for each pregnancy
- Rescreening at the time of delivery for those with new or continued risk factors
- Screening for the first prenatal visit in subsequent pregnancies, regardless of previous HBV vaccination or previous negative hepatitis B surface antigen (HBsAg) results is also covered
High-Risk Factors
The determination of high risk for HBV is identified by the primary care physician who assesses the beneficiary’s history as obtained via the annual wellness visit and considered in developing a comprehensive prevention plan. The medical record should include reflection of the service provided.
- Persons born in countries and regions with a high prevalence of HBV infection
- U.S.-born persons not vaccinated as infants whose parents were born in countries and regions with a high prevalence
- HIV positive persons
- Homosexual men
- Injection drug users
- Persons who live in the same household as an HBV carrier
- Sexual partners of persons with HBV infection
In addition, CMS has determined that repeated screening would be appropriate annually only for beneficiaries with continued high risk (i.e., men who have sex with men, injection drug users, household contacts or sexual partners of persons with HBV infection) who do not receive hepatitis B vaccination.
HCPCS/CPT Coding
- G0499: HBV screening for asymptomatic, nonpregnant adolescents and adults at high risk
- 86704: Hepatitis B core antibody (HBcAb); total
- 86706: Hepatitis B surface antibody (HBsAb)
- 87340: Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg)
- 87341: Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg), neutralization
ICD-10 Diagnosis Coding
For Persons with ESRD
- Z11.59 and N18.6
For Asymptomatic, Nonpregnant Adolescents and Adults at High Risk
- Z11.59 and Z72.89
For Asymptomatic, Nonpregnant Adolescents and Adults, Subsequent Visits
- Z11.59 and one of the codes from pages 22 through 26, of the CMS IOM Medicare Claims Processing Manual, Chapter 18, Preventive and Screening Services
For Pregnant Women
- Z11.59 and one of these: Z34.00, Z34.01, Z34.02, Z34.03, Z34.80, Z34.81, Z34.82, Z34.83, Z34.90, Z34.91, Z34.92, Z34.93
For Pregnant Women at High Risk
- Z11.59 and Z72.89 and one of the following: Z34.00, Z34.01, Z34.02, Z34.03, Z34.80, Z34.81, Z34.82, Z34.83, Z34.90, Z34.91, Z34.92, Z34.93, O09.90, O09.91, O09.92, O09.93
Additional ICD-10 codes may apply. See the CMS ICD-10 webpage for individual CRs and the specific ICD-10-CM codes Medicare covers for this service, and contact your MAC for guidance.
Who Can Perform?
- 01 – General practice
- 08 – Family practice
- 11 – Internal medicine
- 16 – Obstetrics/gynecology
- 37 – Pediatric medicine
- 38 – Geriatric medicine
- 42 – Certified nurse midwife
- 50 – Nurse practitioner
- 89 – Certified clinical nurse specialist
- 97 – Physician assistant
Place of Service
- 11 – Physician’s office
- 22 – On-campus outpatient hospital
- 49 – Independent clinic
- 71 – State or local public health clinic
Cost Sharing
- Copayment/coinsurance waived
- Deductible waived
Reimbursement
- MPFS: Fee Schedule Lookup
Nonparticipating Providers
- Nonparticipating reduction applies
- Limiting charge provision applies
Common Claim Denial Reasons
- Benefit maximum for this time period or occurrence has been reached
Related Content
- CMS IOM Publication 100-03, Medicare National Coverage Determinations (NCDs) Manual, Chapter 1, Coverage Determinations, Part 4, Sections 210.6
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Preventive and Screening Services, Section 170
- MLN® Educational Tool: Medicare Preventive Services
Revised 10/12/2023