Hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are major causes of chronic liver disease. Hepatitis B, which is caused by infection with the Hepatitis B virus (HBV) can be either acute or chronic. The associated illness ranges in severity from asymptomatic to symptomatic, progressive disease. Doctors specialized in treating hepatitis B include gastroenterologists, hepatologists and infectious disease specialists. Medical billing and coding services for hepatitis screening must be based on the guidelines provided by Medicare or other concerned insurance companies. Based on the U.S. Preventive Services Task Force’s updated recommendations for hepatitis B virus (HBV) screening, Medicare has added Part A and Part B coverage for HBV screening, effective September 28, 2016.
The World Health Organization (WHO) estimates that over 350 million people worldwide are chronically infected with HBV. Early identification of chronic HBV or HCV infection enables one to receive the necessary care and treatment to prevent or delay progression of liver disease. As per WHO standards, rapid diagnostic tests for HBV should meet minimum performance standards, and be delivered at the point of care to improve access and linkage to care and treatment.
Medicare Conditions for HBV Screening Coverage
Effective for services performed on or after September 28, 2016, Medicare will cover screening for HBV infection, only if –
- The screening is performed using the appropriate FDA-approved laboratory test, used consistent with FDA-approved labeling and in compliance with the Clinical Laboratory Improvement Act regulations.
- The screening is ordered by the patient’s primary care physician or practitioner in the primary care setting.
- The patient is either an asymptomatic, non-pregnant adolescent/adult at high risk for HBV infection, or pregnant.
- Non-pregnant adolescents/adults at high risk for HBV infection can receive one screening annually.
- Pregnant women should be screened at the first prenatal visit (of each pregnancy) and then rescreened at the time of delivery for those with new or continuing risk factors.
Updates on Procedure and Diagnostic Codes
The claims processing instructions for payment of screening for hepatitis B virus will apply to the following HCPCS, CPT and ICD-10 codes:
- G0499 – Hepatitis B screening in non-pregnant, high risk individual includes hepatitis B surface antigen (hbsag) followed by a neutralizing confirmatory test for initially reactive results, and antibodies to hbsag (anti-hbs) and hepatitis B core antigen (anti-hbc)
- 86704 – Hepatitis B core antibody (HBcAb); total
- 87340 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; hepatitis B surface antigen (HBsAg)
- 87341 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; hepatitis B surface antigen (HBsAg) neutralization
CMS will allow coverage for G0499 for HBV screening only when services are reported with both of the following diagnosis 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 when reported with Z11.59 and one of the following high-risk codes, as appropriate:
- F11.10 – F11.99
- F13.10 – F13.99
- F14.10 – F14.99
- F15.10 – F15.99
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
Medical billing companies must be up-to-date with coding updates made frequently so that physicians will get their reimbursement on-time.