Sunday, May 22, 2016

CPT code sexually transmitted infection screening

Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) to Prevent STIs


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.


• 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

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

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