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January 25, 2018

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Medical Coding News Archives

Coverage for Hepatitis B Screenings Extends Beyond Pregnant Women

May 30, 2017:

In April, the Centers for Medicare and Medicaid Services (CMS) issued a national coverage determination extending coverage to screening for hepatitis B infection. According to CMS instructions, the effective date is September 28, 2016, and the implementation date is January, 1, 2018.

Medicare has covered HBV screening for pregnant women at the first prenatal visit since November 2011 but has not covered it for any other populations. However, CMS recently reviewed the supporting evidence for the screening and determined that it does meet the coverage criteria for preventive services:

  • It is reasonable and necessary for preventing and detecting illness or disability early.
  • It is recommended with a grade of A or B by the United States Preventive Services Task Force (USPSTF).
  • It is appropriate for beneficiaries under Part A or Part B.

The screening is covered for asymptomatic, nonpregnant adolescents and adults at high risk for HBV infection. People are considered high risk if they:

  • Were born in countries and regions with greater than or equal to a 2 percent rate of HBV infection
  • Were born in the United States but were not vaccinated as infants and their parents were born in regions with an HBV infection rate greater than or equal to 8 percent.
  • Are HIV-positive
  • Are men who have had sex with men
  • Are injection drug users
  • Have household contact with or are sexual partners of people infected with HBV

The screening is also still covered for all pregnant women at their first prenatal screening and at the time of delivery if there are new or continuing risk factors.


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