Medicare Preventive Screening for Hep. C

Effective June 2, 2014, Medicare began coverage of preventative screenings for Hepatitis C as part of the overall package of enhanced preventative services under the Patient Protection and Affordable Care Act. The Centers for Medicare and Medicaid Services (CMS) have just revised their guidance on billing for the service in Medlearn Matters Article MM8871.

In summary, the screen is billable using the new HCPCS G0472. HCPCS G0472 will appear in the January 2015 recurring updates of the Medicare Physician Fee Schedule Data Base (MPFSDB) and the Integrated Outpatient Code Editor (IOCE) with a June 2, 2014 effective date. Contractors shall apply contractor pricing to claims with dates of service June 2, 2014, through Dec. 31, 2014, that contain HCPCS G0472. Beneficiary cost sharing does not apply. For services provided to beneficiaries born between the years 1945 and 1965 who are not considered high risk, the screening is limited to once per lifetime.

For complete details please refer to MM8871 linked above.

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827