Health Information Management

Healthcare News: Medicare adds screening services to covered list

JustCoding News: Outpatient, March 7, 2012

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CMS continues to add more screening services to the list of covered preventative services. The newest additions involve screenings for sexually transmitted infections (STI).

CMS announced that coverage is available for tests that screen for STIs—specifically chlamydia, gonorrhea, syphilis, and hepatitis B—occurring on or after November 8, 2011 in Transmittal 2402 in the Medicare Claims Processing Manual and MLN Matters MM7610. The patient’s primary care provider must order the appropriate Food and Drug Administration approved/cleared laboratory tests.

In addition, Medicare will cover high intensity behavioral counseling (HIBC) to prevent STIs. CMS created a new HCPCS code for this service:

  • G0445 – High-intensity behavioral counseling to prevent sexually transmitted infections, face-to-face, individual, includes: education, skills training, and guidance on how to change sexual behavior, performed semi-annually, 30 minutes

Medicare will pay for one G0445 code on the same date of service as an annual wellness visit, during the global billing period for obstetrical care, or with a medically necessary E/M service as long as the practitioner provided a distinct service and reports an appropriate diagnosis code for the E/M that is different from the diagnosis code for the G0445 service.

Medicare will cover up to two HIBC sessions annually for sexually active adolescents and adults with increased risky behavior. The following list, based on the United States Preventive Services Task Force guidelines exhibit high-risk factors that will qualify for the HIBC:

  • Multiple sex partners
  • Using barrier protection inconsistently
  • Having sex under the influence of alcohol or drugs
  • Having sex in exchange for money or drugs
  • Age (24 years of age or younger and sexually active for women for chlamydia and gonorrhea)
  • Having an STI within the past year
  • IV drug use (hepatitis B only)
  • In addition, for men – men having sex with men and engaged in high-risk sexual behavior, but no regard to age

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