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Hepatitis C Virus (HCV) Screening

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

  • Copayment/coinsurance waived
  • Deductible waived

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