HCPCS/CPT Codes
86631, 86632, 87110, 87270, 87320, 87490,
87491, 87810 – Chlamydia
87590, 87591, 87850 – Neisseria gonorrhoeae
87800 – Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; direct probe(s) technique
86592 – Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART)
86593 – Syphilis test, non-treponemal, quantitative
86780 – Treponema pallidum
87340, 87341 – Hepatitis B (hepatitis B surface antigen)
G0445 – Semiannual high intensity behavioral counseling to prevent STIs, individual, face-toface, includes education skills training & guidance on how to change sexual behavior, 30 minutes
ICD-10-CM Codes
Z11.3, Z72.89, Z72.51, Z72.52, Z72.53, Z34.00,
Z34.01, Z34.02, Z34.03, Z34.80, Z34.81, Z34.82,
Z37.83, Z34.90, Z34.91, Z34.92, Z34.93, O09.90,
O09.91, O09.92, and O09.93
Who Is Covered
Certain Medicare beneficiaries who are:
• Sexually active adolescents and adults at increased risk for STIs; and • Referred for this service by a primary care provider and provided by a Medicare-eligible
primary care provider in a primary care setting
NOTE: More information on covered beneficiaries and a definition of “increased risk for STIs” can be found in the Medicare National Coverage Determinations Manual, Publication 100-03, Chapter 1, Section 210.10.
Frequency
• One annual occurrence of screening for chlamydia, gonorrhea, and syphilis in women at increased risk who are not pregnant
• One annual occurrence of screening for syphilis in men at increased risk
• Up to two occurrences per pregnancy of screening for chlamydia and gonorrhea in pregnant women who are at increased risk for
STI screening CODES
CPT Code 86631: Antibody; Chlamydia
CPT Code 86632: Antibody; Chlamydia, IgM
CPT Code 86780: Antibody; Treponema pallidum
CPT Code 87110: Culture, Chlamydia, any source
CPT Code 87270: Infectious agent antigen detection by immunofluorescent technique; Chlamydia trachomatis
CPT Code 87320: Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Chlamydia trachomatis
CPT Code 87340: Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg)
CPT Code 87341: Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg) neutralization
CPT Code 87490: Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, direct probe technique
CPT Code 87491: Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique
CPT Code 87590: Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhea, direct probe technique
CPT Code 87591: Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhea, amplified probe technique
CPT Code 87800: Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; direct probe(s) technique
CPT Code 87810: Infectious agent antigen detection by immunoassay with direct optical observation; Chlamydia trachomatis
CPT Code 87850: Infectious agent antigen detection by immunoassay with direct optical observation; Neisseria gonorrhea
STIs and continued increased risk for the second screening
• One occurrence per pregnancy of screening for syphilis in pregnant women; up to two additional occurrences in the third trimester and at delivery if at continued increased risk for STIs
• One occurrence per pregnancy of screening for hepatitis B in pregnant women; one additional occurrence at delivery if at continued increased risk for STIs
• Up to two 20-30 minute, face-to-face HIBC counseling sessions annually Beneficiary Pays
• Copayment/coinsurance waived
• Deductible waived
Chlamydia Infection Screening
Procedure Code(s): 86631, 86632, 87110, 87270, 87320, 87490, 87491, 87492, 87801, 87810, 36415, 36416
Diagnosis Code(s):
• ICD-9: V70.0, V73.88, V73.98, V74.5, V75.9,
• ICD-10: Z00.00, Z00.01, Z11.3, Z11.8, Z11.9, Z20.2 OR Pregnancy (see list at end of section).
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