Tuesday, September 27, 2011

CPT code G0432, G0433, G0435, G0475, 80081 - icd code dx v73.89

Human Immunodeficiency Virus (HIV) Screening


Effective April 13, 2015, procedure code G0475 may be billed for HIV screening. Refer to “Screening for the Human Immunodeficiency Virus (HIV) Infection” for more information.

HCPCS/CPT Codes

80081 – Obstetric panel (includes HIV testing)

G0432 – Infectious agent antibody detection by enzyme immunoassay (EIA) technique

G0433 – Infectious agent antibody detection by enzyme-linked immunosorbent assay (ELISA) technique

G0435 – Infectious agent antibody detection by rapid antibody test

G0475 – HIV antigen/antibody, combination assay, screening

ICD-10 Codes

Increased risk factors not reported – Z11.4

Increased risk factors reported – Z11.4 and Z72.89, Z72.51, Z72.52, or Z72.53 Pregnant Medicare beneficiaries – Z11.4 and Z34.00, Z34.01, Z34.02, Z34.03, Z34.80, Z34.81, Z34.82, Z34.83, Z34.90, Z34.91, Z34.92, Z34.93, O09.90, O09.91,

O09.92, or O09.93

Who Is Covered

Certain Medicare beneficiaries who are at increased risk for HIV infection, including anyone who asks for the test, or pregnant women

NOTE: “Increased risk for HIV infection” is defined in the Medicare National Coverage Determinations Manual, Publication 100-03, Chapter 1, Section 210.7 Frequency

* Annually for Medicare beneficiaries between the ages of 15 and 65 without regard to perceived risk

* Annually for Medicare beneficiaries younger than 15 and adults older than 65 who are at increased risk for HIV infection

* For Medicare beneficiaries who are pregnant, 3 times per pregnancy:First, when a woman is diagnosed with pregnancy Second, during the third trimester Third, at labor, if ordered by the woman’s clinician Medicare Beneficiary Pays

 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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