Description:
For Asymptomatic, Nonpregnant Adolescents and Adults at High Risk

G0499 – Hepatitis b screening in non-pregnant, high risk individual includes hepatitis b surface antigen (hbsag) followed by a neutralizing confirmatory test for initially reactive results, and antibodies to hbsag (anti-hbs) and hepatitis b core antigen (anti-hbc)

For Pregnant Women

86704 – Hepatitis B core antibody (HBcAb); total
86706 – Hepatitis B surface antibody (HBsAb)
87340 – Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg)
87341 – Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg) neutralization

Limitations:
ICD-10 Codes

For Persons With End-Stage Renal Disease (ESRD)

Z11.59 and N18.6

For Asymptomatic, Nonpregnant Adolescents and Adults at High Risk

Z11.59 and Z72.89

For Asymptomatic, Nonpregnant Adolescents and Adults, Subsequent Visits

Z11.59 and one of the following: F11.10–F11.988, F13.10–F13.988, F14.10–F14.988, F15.10–F15.988, Z20.2, Z20.5, Z72.52, Z72.53

For Pregnant Women

Z11.59 and one of the following: Z34.00, Z34.01, Z34.02, Z34.03, Z34.80, Z34.81, Z34.82, Z34.83, Z34.90, Z34.91, Z34.92, Z34.93

For Pregnant Women at High Risk

Z11.59 and Z72.89 and one of the following: 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, O09.93

NOTE: Additional ICD-10 codes may apply. See the CMS ICD-10 webpage for individual Change Requests (CRs) and the specific ICD-10-CM codes Medicare covers for this service, and contact your Medicare Administrative Contractor (MAC) for guidance.•Z72.89 - Other Problems related to life style.

For claims with dates of service on or after September 28, 2016, CMS will allow coverage for G0499 for subsequent visits, only when services are reported with the following diagnosis codes:

•Z11.59 and one of the high risk codes below
- F11.10-F11.99
- F13.10-F13.99
- F14.10-F14.99
- F15.10-F15.99
- Z20.2 - Z20.5
- Z72.52 - Z72.53


Frequency Limitations:
One screening for asymptomatic, nonpregnant adolescents and adults who do not meet the high risk definition
Annually only for those who have continued high risk who do not receive hepatitis B vaccination
One screening for pregnant women at the first prenatal visit for each pregnancy and rescreening at the time of delivery for those with new or continued risk factors

NOTE: This includes screening during the first prenatal visit in subsequent pregnancies, regardless of previous HBV vaccination or previous negative hepatitis B surface antigen test results.