Help your organization join the fight against Hepatitis B (HBV) infection by understanding what conditions are necessary for coverage of HBV screening and how to properly code the Hepatitis B surface antigen (HBsAg) serologic test. Here is a breakdown what you need to know when coding for HBV screening to ensure reimbursement.

The article Stop Hepatitis B via HBsAg Screening in Pregnant Women covers the recommendation released by U.S. Preventive Services Task Force reaffirming that screening for HBV infection in pregnant women provides substantial benefit. The Centers for Medicare & Medicaid Services (CMS) deems screening for HBV infection reasonable and necessary and provides coverage for individuals entitled to benefits under Part A or Part B for services performed on or after September 28, 2016. Naturally, there are conditions for coverage.

Conditions for Coverage of HBsAg Serologic Testing

• The patient’s primary care physician or practitioner,  an eligible Medicare provider, must order the screening within the context of a primary care setting.
• The screening must be performed by appropriate U.S. Food and Drug Administration (FDA) approved/cleared laboratory tests, used consistent with FDA approved labeling and in compliance with the Clinical Laboratory Improvement Act (CLIA) regulations.
• Patients must be either:
  • Pregnant – A screening test at the first prenatal visit is covered and then rescreening at time of delivery for those with new or continuing risk factors.
    • Screening for each pregnancy, regardless of previous hepatitis B vaccination or previous negative HBsAg test results.
  • Asymptomatic, nonpregnant adolescent/adult at high risk for HBV infection.
    • Coverage provides one screening annually.

Note: See National Coverage Determination for Screening for HBV Infection for definitions of “high risk for HBV,” “primary care physician/practitioner,” and “primary care setting.”

Procedure Coding for HBV Screening

Diagnosis Coding for HBV Screening

For HBV screening in pregnant women (CPT codes 86704, 86706, 87340 and 87341) report Z11.59 Encounter for screening for other viral diseases with one of the following diagnosis codes:

• Z34.00 – Encounter for supervision of normal first pregnancy, unspecified trimester
• Z34.80 – Encounter for supervision of other normal pregnancy, unspecified trimester
• Z34.90 – Encounter for supervision of normal pregnancy, unspecified, unspecified trimester
• O09.90 – Supervision of high risk pregnancy, unspecified, unspecified trimester

For HBV screening in pregnant women at high risk, report the appropriate CPT code with Z11.59, Z72.89 Other problems related to lifestyle and one of the following ICD-10-CM codes, as appropriate:

• Z34.00 – Z34.03 – Encounter for supervision of normal first pregnancy
• Z34.80 – Z34.83 – Encounter for supervision of other normal pregnancy
• Z34.90 – Z34.93 – Encounter for supervision of normal pregnancy, unspecified
• O09.90 – O09.93 – Supervision of high risk pregnancy, unspecified

For non-pregnant adolescents/adults at high risk for HBV infection, CMS will allow coverage for G0499 only when services are reported with the following diagnosis codes denoting high risk:

• Z11.59 – Encounter for screening for other viral disease
• Z72.89 – Other Problems related to lifestyle

CMS will allow coverage for G0499 for subsequent visits when reported with Z11.59 and one of the following high-risk codes, as appropriate:

• F11.10-F11.99
• F13.10-F13.99
• F14.10-F14.99
• F15.10-F15.99
• Z20.2
• Z20.5
• Z72.52
• Z72.53

For additional billing and coding specifications and requirements see MLN Matters MM9859.