Sexually transmitted infections (STIs) screening and high intensity behavioral counseling (HIBC) to prevent STIs
Medicare covers STI screening and HIBC for certain Medicare beneficiaries when all of the following are true:
- Sexually active adolescents and adults at increased risk for STIs
- Referred for this service by a primary care provider and provided by a Medicare-eligible primary care provider in a primary care setting
HCPCS/CPT codes
- Chlamydia:
- 86631 – Antibody; Chlamydia
- 86632 – Antibody; Chlamydia, IgM
- 87110 – Culture, chlamydia, any source
- 87270 – Infectious agent antigen detection by immunofluorescent technique; Chlamydia trachomatis
- 87320 – 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; Chlamydia trachomatis
- 87490 – Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, direct probe technique
- 87491 – Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique
- 87810 – Infectious agent antigen detection by immunoassay with direct optical observation; Chlamydia trachomatis
- 87800 – Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; direct probe(s) technique
- Use 87800 when performing combined chlamydia and gonorrhea testing
- Gonorrhea:
- 87590 – Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoea, direct probe technique
- 87591 – Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoea, amplified probe technique
- 87850 – Infectious agent antigen detection by immunoassay with direct optical observation; Neisseria gonorrhoea
- 87800 – Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; direct probe(s) technique
- Use 87800 when performing combined chlamydia and gonorrhea testing
- Chlamydia and Gonorrhea:
- 402U – Infectious agent (sexually transmitted infection), Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma genitalium, multiplex amplified probe technique, vaginal, endocervical, or male urine, each pathogen reported as detected or not detected
- 0455U – Infectious agents (sexually transmitted infection), Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis, multiplex amplified probe technique, vaginal, endocervical, gynecological specimens, oropharyngeal swabs, rectal swabs, female or male urine, each pathogen reported as detected or not detected
- 87494 – Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis and Neisseria gonorrhoeae, multiplex amplified probe technique
Note: Don’t report 87494 with 87491 or 87591
- Syphilis:
- 86592 – Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART)
- 86593 – Syphilis test, non-treponemal antibody, quantitative
- 86780 – Antibody; Treponema pallidum
- Hepatitis B (Hepatitis B Surface Antigen):
- 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
- High intensity behavioral counseling (HIBC):
- G0445 – High intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes education, skills training, and guidance on how to change sexual behavior; performed semi-annually, 30 minutes
Frequency
- One annual occurrence of screening for chlamydia, gonorrhea, and syphilis in women at increased risk who are not pregnant
- One annual occurrence of screening for syphilis in men at increased risk
- Up to two occurrences per pregnancy of screening for chlamydia and gonorrhea in pregnant women who are at increased risk for STIs and continued increased risk for the second screening.
- One occurrence per pregnancy of screening for syphilis in pregnant women:
- Up to two additional occurrences in the third trimester and at delivery if at continued increased risk for STIs
- One occurrence per pregnancy of screening for hepatitis B in pregnant women
- One additional occurrence at delivery if at continued increased risk for STIs:
- Up to two 30-minute, face-to-face HIBC sessions annually
References