Tuesday, September 27, 2011

CPT code G0432, G0433, G0435 - dx v73.89

Human Immunodeficiency Virus (HIV) Screening

 This is a new benefit beginning for dates of service on and after 12/08/09

CPT code G0432 – Infectious agent antibody detection by enzyme immunoassay (EIA) technique, HIV-1 and/or HIV-2, screening
CPT code G0433 – Infectious agent antibody detection by enzyme-linked immunosorbent assay (ELISA) technique, HIV-1 and/or HIV-2, screening
G0435 – Infectious agent antibody detection by rapid antibody test, HIV-1 and/or HIV-2, screening
Report one of the following codes:

V73.89 – Primary
V22.0, V22.1, V69.8, or V23.9 – Secondary, as appropriate

Beneficiaries who are at increased risk for HIV infection or pregnant**
** Increased risk for HIV infection is defined in the “National Coverage Determinations (NCD) Manual,” Publication 100-03, Sections 190.14 (diagnostic) and 210.7 (screening). See http://www.cms.gov/ manuals/downloads/ncd103c1_Part3.pdf and http://www.cms.gov/manuals/ downloads/ncd103c1_Part4.pdf on the Internet.

Annually for beneficiaries at increased risk Three times per pregnancy for beneficiaries who are pregnant:

a.    When woman is diagnosed with pregnancy;
b.    During the 3rd trimester; and c.   At labor, if ordered by the woman’s clinician.

Copayment/coinsurance waived
Deductible waived

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