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June 13, 2018

Preventive Testing for Human Immunodeficiency Virus (HIV)

The Centers for Disease Control and Prevention (CDC) recognize June 27 as National HIV Screening Day (NHTD).  Medicare allows HIV Screening services for beneficiaries.  This benefit and testing are significant as statistics from the CDC indicate there are approximately 1.1 million people living with HIV and 15% of them do not know they have the disease.  Most new HIV infections (92%) are transmitted by persons not aware they are infected or not receiving treatment.

Medicare policy indicates that coverage is offered to certain Medicare beneficiaries without regard to perceived risk or those at increased risk, and pregnant women. National Coverage Determination (NCD) for Screening for the Human Immunodeficiency Virus (HIV) Infection (210.7)External PDF explains the coverage criteria for this critical test available to beneficiaries.  You may also refer to the Medicare Preventive Services Quick Reference ChartExternal Website for the appropriate diagnosis coding for this service along with the frequency parameters.  Where Medicare covers this screening, the copayment and deductible are waived.

This document was developed through the A/B Medicare Administrative Contractor (MAC) Provider Outreach & Education (POE) Collaboration Team. This joint effort ensures consistent communication and education throughout the nation on a variety of topics and will assist the provider and physician community with information necessary to submit claims appropriately and receive proper payment in a timely manner.

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