Sexually Transmitted Infections and High Intensity Behavioral Counseling to Prevent STIs are now Preventive Services

March 7th, 2012

Medicare, Medicaid and most private insurors are now required to pay for screening for STIs and High Intensity Behavioral Counseling (HIBC) to prevent STIs. The tests are not subject to coinsurance or deductibles.

The tests must be ordered by a primary care provider; and the HIBC must be provided in primary care settings including family practice, internal medicine and ob-gyn offices.  Hospital based care including emergency departments are not considered primary care settings for these services.

STIs included are Chlamydia (86631, 86632, 87110, 87270, 87320, 87490, 87491, 87810, 87800 (used for combined Chlamydia and gonorrhea testing), gonorrhea (87590, 87591, 87850, 87800 (used for combined Chlamydia and gonorrhea testing), syphilis (86592, 86593, 86780), and hepatitis B (hepatitis B surface antigen) 87340, 87341)). 

Codes V74.5 or V73.89 and V69.8, denoting STI screening and high-risk behavior, respectively, and/or V22.0, V22.1, or V23.9, denoting pregnancy as appropriate must be included for the tests to be treated as preventive.

Bill new code 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)  for HIBC.  CMS will cover semi-annual sessions, twenty to thirty minutes in length, per year.  The code pays approximately $24 depending on your jurisdiction.

The visit must be linked to the correct diagnosis code.  Per CMS in MLN Matters® Number: MM7610:

  • The appropriate screening diagnosis code (ICD-9-CM V74.5 (screening bacterial – sexually transmitted) or V73.89 (screening, disease or disorder, viral, specified type NEC)), when used with the screening lab tests identified by Change Request (CR) 7610, will indicate that the test is a screening test covered by Medicare.
  • Diagnosis code V69.8 (other problems related to life style) is used to indicate that the beneficiary is at high/increased risk for STIs. Providers should also use V69.8 for sexually active adolescents when billing G0445 counseling services.
  • Diagnosis codes V22.0 (supervision of normal first pregnancy), V22.1 (supervision of other normal pregnancy), or V23.9 (supervision of unspecified high-risk pregnancy) are also to be used when appropriate.

This code may be paid on the same date of service as an annual wellness visit (AWV), evaluation and management (E&M) code, or during the global billing period for obstetrical care..

An E&M code should not be billed when the sole reason for the visit is HIBC to prevent STIs. If there is a different diagnosis, however, both may be billed on the same day.

Please review MLN Matters® Number: MM7610 for details on documentation requirements.

Tags: Preventive Services, STIs


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