The Hepatitis B virus (HBV) and the Hepatitis C virus (HCV) are the two main viruses that cause chronic liver disease. Physicians with treating hepatitis B, such as infectious disease specialists, hepatologists, and gastroenterologists, can rely on medical billing and coding services to ensure accurate reporting of their services to Medicare and other health insurance providers.
HBV can cause both acute and chronic hepatitis B. This virus is commonly transmitted through contact with the blood, semen, or other body fluids of the infected person. The symptoms of HBV infection may include nausea, anorexia, fatigue, fever, and abdominal pain. Some persons may not have any symptoms at all. An acute HBV infection has the potential to progress into a chronic infection, leading to severe and potentially life-threatening complications such as cirrhosis, liver failure, hepatocellular carcinoma, and even death.
According to the World Health Organization (WHO), 296 million people were living with chronic hepatitis B infection in 2019. The Hepatitis B Foundation estimates about 1.5 million new infections occur each year. Of these, almost 300 million are chronic infections and approximately 10% of infected individuals are diagnosed. Hepatitis B causes approximately two deaths each minute.
When chronic HBV or HCV infection is detected early, treatment and care can stop or slow the progression of liver disease. In order to improve access and linkage to care and treatment, rapid diagnostic tests for HBV should be provided at the point of care and meet minimum performance standards, according to WHO guidelines.
HBV Screening and Testing Recommendations 2023 – Key Points
Here are key points ofCDC’s recently published updated recommendations for hepatitis B screening and testing.
- Screen all adults aged 18 years and older at least once in their lifetime using a triple panel test
- Screen pregnant people for hepatitis B surface antigen (HBsAg) during each pregnancy regardless of vaccination status and history of testing
- Expand periodic risk-based testing to include people incarcerated, people with a history of sexually transmitted infections or multiple sex partners, and people with hepatitis C virus infection
- Test anyone who requests HBV testing regardless of disclosure of risk
CDC recommends testing people at increased risk periodically, regardless of age with ongoing risk for exposures, while risk for exposures persists.
Medicare Requirements for Coverage of HBV Screening
If the individual’s primary care doctor orders the test, Medicare Part B will cover hepatitis B screenings once a year when they at high risk and aren’t vaccinated. Conditions for Medicare coverage of HBV screening:
- Medicare covers HBV screenings for asymptomatic, nonpregnant adolescents and adults at high risk for HBV infection. Screenings are covered without any deductibles or copays.
- A screening test at the first prenatal visit is covered for pregnant women and then rescreening at time of delivery for those with new or continuing risk factors. In addition, CMS has determined that screening during the first prenatal visit would be appropriate for each pregnancy, regardless of previous hepatitis B vaccination or previous negative HBsAg test results.
- The test is ordered by the primary care physician or practitioner who assesses the patient’s history and determines “high risk for HBV”.
- The screening is carried out in accordance with the Clinical Laboratory Improvement Act regulations, using the relevant FDA-approved laboratory test, and in accordance with FDA-approved labelling.
- The medical record should reflect the service provided.
Codes for HBV Screening
The claims processing instructions for payment of screening for hepatitis B virus applies to the following HCPCS and CPT codes:
Code G0499 – HBV screening for asymptomatic, non-pregnant adolescents and adults at high risk.
Hepatitis b screening in non-pregnant, high risk individual includes hepatitis b surface antigen (hbsag), antibodies to hbsag (anti-hbs) and antibodies to hepatitis b core antigen (anti-hbc), and is followed by a neutralizing confirmatory test, when performed, only for an initially reactive hbsag result.
The ICD-10 codes for hepatitis B are:
- B16 (acute hepatitis B)
- B18 (chronic viral hepatitis)
- CMS allows coverage for G0499 for HBV screening only when services are reported with both of the following ICD-10 codes denoting high risk:
- Z11.59 – Encounter for screening for other viral disease
- Z72.89 – Other problems related to life style
- CMS will allow coverage for G0499 for subsequent visits, only when services are reported with the following diagnosis codes:
- Z11.59 and one of the high risk codes below
- Z20.2 – Z20.5
- Z72.52 – Z72.53
For HBV screening in pregnant women, report the appropriate CPT code with Z11.59 and one of the following:
- Z34.00 Encounter for supervision of normal first pregnancy, unspecified trimester
- Z34.80 Encounter for supervision of other normal pregnancy, unspecified trimester
- Z34.90 Encounter for supervision of normal pregnancy, unspecified, unspecified trimester
- O09.90 Supervision of high risk pregnancy, unspecified, unspecified trimester
For HBV screening in pregnant women at high risk, report the appropriate CPT code with Z11.59, Z72.89, and one of the following ICD-10-CM codes, as appropriate:
- Z34.00 – Z34.03
- Z34.80 – Z34.83
- Z34.90 – Z34.93
- O09.90 – O09.93
- 86704 Hepatitis B core antibody (HBcAb); total
- 86705 Hepatitis B core antibody (HBcAb); IgM antibody
- 86706 Hepatitis B surface antibody (HBsAb)
- 86707 Hepatitis Be antibody (HBeAb)
- 87340 Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; hepatitis B surface antigen (HBsAg)
- 87341 Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; hepatitis B surface antigen (HBsAg) neutralization If reflex testing is performed, concomitant CPT code(s)/charge(s) will apply.
Viral hepatitis poses a significant and preventable risk to public health that puts people who are infected at increased risk for liver disease, cancer, and death. Accurate reporting of hepatitis B screenings are essential elements of the overall strategy to curb the spread of the virus, improve patient outcomes, and support broader public health initiatives. Relying on an experienced medical billing and coding company can help providers ensure correct coding that helps justify the necessity of screenings and ensure that patients continue to receive these vital services.
Ensure precise documentation and claim submission for financial success!