HCPCS code G0432, G0433, G0435 and ICD 10 Z11.4, Z72.89

Human Immunodeficiency Virus (HIV) Screening
HCPCS/CPT Codes

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


ICD-10-CM Codes

High risk – Z11.4 and Z72.89

Not high risk – Z11.4

Pregnant 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 beneficiaries at increased risk, including anyone who asks for the test For beneficiaries who are pregnant, 3 times per pregnancy:

• First, when a woman is diagnosed with pregnancy;

• Second, during the third trimester; and

• Third, at labor, if ordered by the woman’s clinician


Beneficiary Pays

• Copayment/coinsurance waived
• Deductible waived


HIV – Human Immunodeficiency

Virus – Screening for Adolescents and Adults (Males and Females)

Procedure Code(s): 86689, 86701, 86702, 86703, G0432, G0433, G0435, G0475, S3645, 36415, 36416

Diagnosis Code(s):

• ICD-9: V02.9, V70.0, V73.89, V74.5, V75.9,

• ICD-10: Z00.00, Z00.01, Z22.6, Z22.8, Z22.9, Z11.3, Z11.4, Z11.59, Z11.9,  Z20.6

OR Pregnancy (see list at end of section).

Adolescents and adults, including pregnant women.