Hepatitis C virus (HCV)
Medicare covers the hepatitis C virus for certain adult Medicare beneficiaries who fall into at least one of the following categories:
- High risk for HCV infection
- Born between 1945 and 1965
- Had a blood transfusion before 1992
HCPCS/CPT code
- G0472 - Hepatitis C antibody screening, for individual at high risk and other covered indications(s)
- G0567 - Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, screening, amplified probe technique (Effective June 27, 2024; implementation October 20, 2025)
Frequency
- Once for Medicare beneficiaries born from 1945 through 1965 who are not considered high risk (use ICD-10 Z11.59; effective October 1, 2017)
- An initial screening for Medicare beneficiaries, regardless of birth year, for adults at high risk, that is, beneficiaries who had a blood transfusion before 1992 and beneficiaries with a current or past history of illicit injection drug use
- Annually only for high-risk Medicare beneficiaries with continued illicit injection drug use since the prior negative (HCV) screening test
Deductible and coinsurance are waived for service.
References